Jay Tor

Here's an article published back in 1999 - basically, one of the problems is that people being treated for one condition/disease may not know that they also have another condition/disease. So far, none of the sci/med literature to date shows any hint that actonel or any other bisphosphonate might cause or contribute to pulmonary dysfunction. I'm interested in this because one of my kids was at high risk of OP because of massive doses of prednisone needed to manage a more serious condition.

This is the article:

Men With Chronic Lung Disease At High Risk For Osteoporosis

CHICAGO, IL -- December 14, 1999 -- Men with chronic lung disease are more than five times as likely to develop osteoporosis than those without chronic lung disease. If they are on chronic glucocorticoid therapy, a common asthma treatment, they are nine times more likely to develop osteoporosis. These are the key findings in a new study appearing in the December issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP).

Appearing in the same issue of CHEST is a literature review on the association between glucocorticoid therapy and osteoporosis in which the authors state that specialists and generalists alike, fail to recognize asymptomatic bone loss in high risk lung patients and miss the opportunity to prevent, slow or reverse bone loss progress.

Previous studies have suggested an association between chronic obstructive lung disease and osteoporosis in men as well as glucocorticoid-induced osteoporosis. According to researchers at Emory University and the Veterans' Administration Medical Center in Atlanta, the relative contributions of chronic lung disease, drug therapy and other factors contributing toward bone loss in men had not been established. They conducted a cross sectional medical survey among 171 patients between the ages of 23 and 90. Medical charts were reviewed and additional information was obtained from an electronic database of laboratory values and pharmacy records. Patients also underwent bone density measurement of the spine and left hip.

Patients were assigned to one of four groups: those with chronic lung disease being treated with oral glucocorticoid therapy; those with chronic lung disease being treated with inhaled glucocorticoid therapy; those with chronic lung disease not receiving treatment with glucocorticoids; and, a control group which did not have chronic lung disease and were not on glucocorticoid therapy.

Mark S. Nanes, M.D. and colleagues reported that bone density measurement did not show any difference in mean density between those with chronic obstructive lung disease (COPD) and asthma so both types of patients were pooled into one group. He also noted that chronic lung disease patients being prescribed inhalation glucocorticoid therapy had an overall bone loss that was indistinguishable from those who were receiving oral glucocorticoid therapy. Other studies have found the connection with osteoporosis to be less strong with inhaled glucocorticoids than with oral glucocorticoids.

Chronic lung disease patients without any glucocorticoid therapy had five times the likelihood of developing osteoporosis as compared to the control group. Chronic lung patients on glucocorticoid therapy had a nine-fold chance of developing osteoporosis compared with the control group.

The investigators said: "Patients with chronic lung disease comprise a high-risk group for osteoporosis. In comparison to postmenopausal women for whom the prevalence of osteoporosis is as much as 30 percent, men with chronic lung disease have an almost identical burden of disease." They added that recent prospective data suggest that the relationship between bone mass density and fracture incidence is the same for men and women. "Thus," they concluded, "it would be prudent to consider men with chronic lung disease for bone density screening even if they are not treated with glucocorticoid therapy."

Marc F. Goldstein, M.D., FCCP, of the Asthma Center in Philadelphia, and colleagues conducting the literature review reported that the prevalence of glucocorticoid-induced osteopenia (reduced bone mass) and osteoporosis has been shown to be as high as 62 percent in asthma populations. They said although chronic glucocorticoid therapy clearly reduces the morbidity of persistent asthma, it must be used prudently in light of the numerous side effects. "Clearly," the authors said, "reducing the prevalence of glucocorticoid-induced bone loss in patients with COPD and asthma will require the following: the appropriate use of nonsteroidal anti-inflammatory therapy to limit exposure to glucocorticoid therapy; the understanding of adverse effects of chronic oral and inhaled glucocorticoid therapy; the early identification and evaluation of asthma and COPD patients who experience bone loss; the utilization of agents that attenuate bone resorption and promote bone formation; and, the ability to quickly, precisely, and inexpensively assess improvements in bone mass density in response to therapy."

Hope this answers some of your concerns,
Jay