BONE-MINERAL DENSITY AND BODY-COMPOSITION IN PATIENTS WITH AIR-FLOW OBSTRUCTION - THE ROLE OF INHALED STEROID-THERAPY, DISEASE AND LIFE-STYLE

Background Inhaled steroid therapy has been shown to be associated wit h low bone mineral density (BMD) in asthmatic patients, but its effect in men has not been specifically studied; and the relative importance of therapy, disease and lifestyle leading to low BMD has not been inv estigated. Objectives The study was designed to compare BMD in women a nd men who had airflow obstruction (asthma or GOAD with or without inh aled steroid therapy) with normal controls. The role of inhaled steroi d treatment, disease severity and lifestyle was studied among patients . Methods One hundred and fourty-four patients (106 on inhaled steroid s and 38 not on inhaled steroids) and 212 age-matched controls were st udied. Body composition and BMD (at the total body, hip and spine) wer e measured by dual-X-ray densitometry (DEXA). Forced expiratory volume (FEV1) was measured in patients. A validated questionnaire was admini stered to measure lifestyle factors. Results The body mass indices (BM I) (P < 0.001) and percentage of body fat (P < 0.001) were higher amon g female patients on inhaled steroids than controls. However, the BMD of the total body (P < 0.05) and spine (P < 0.001) were significantly lower in premenopausal and postmenopausal women than controls, respect ively (P < 0.005). The BMD at the spine (P < 0.01) and hip (P < 0.01) in male patients were significantly lower than the controls. By multip le regression, age and use of inhaled steroid was negatively associate d with BMD at the hip (P < 0.01), but not at the spine (P > 0.05). Cig arette smoking was associated with significantly lower BMD at the femo ral neck (P < 0.05), and a low dietary calcium intake was associated w ith lower BMD at the spine (P < 0.05). In women, use of inhaled steroi d was not associated with significantly lower BMD. Conclusion Men who had asthma and/or GOAD had lower BMD, and this was not attributable en tirely to steroid use. Cigarette smoking and a low dietary calcium int ake may partially account for this difference. The difference in BMD b etween female patients and controls, even in those taking inhaled ster oid, was small.