BONE-MINERAL DENSITY OF THE PROXIMAL FEMUR AND LUMBAR SPINE IN GLUCOCORTICOID-TREATED ASTHMATIC-PATIENTS

The importance of the proximal femur as a site of osteoporotic fractures, the development of techniques for bone mineral density (BMD) measurement at this site and the apparent selectivity of the osteopenic effects of glucocorticoids have focused attention on the assessment of proximal femoral BMD in steroid-treated subjects. We have, therefore, measured BMD (Lunar DPX) in the lumbar spine and proximal femur of 31 asthmatic patients receiving long-term glucocorticoid therapy (mean +/- SEM dose 16 +/- 1 mg prednisone/day, mean duration 10 +/- 2 years). BMD values expressed as the percentage of normal age- and sex-appropriate mean values, after weight adjustment, were as follows: lumbar spine 80 +/- 2%, femoral neck 83 +/- 2%, Ward's triangle 78 +/- 3% and trochanter 86 +/- 2%. All these values were significantly less than control (p < 0.0001) and the decrement in BMD was more marked in Ward's triangle than at the other two femoral sites (p < 0.05). In all regions BMD was unrelated to dose or duration of steroid treatment. It is concluded that there are reductions in the BMD of the lumbar spine and proximal femur in glucocorticoid-treated asthmatics, probably reflecting the mixed cortical/trabecular makeup of both regions.