Chest
Original ResearchCOPDPrevalence and Progression of Osteoporosis in Patients With COPD: Results From the Towards a Revolution in COPD Health Study
Section snippets
Design Overview, Setting, and Participants
Details of the TORCH study design and analyses have been published in detail elsewhere.13, 14 The authors of the TORCH study evaluated outpatients with moderate-to-severe COPD in 444 centers across 42 countries. The BMD study was conducted in 88 of these centers in the United States. Patients requiring OCS or long-term oxygen therapy at study entry were excluded. All patients gave written informed consent prior to participation in the study, which was approved by local ethical review boards,
Results
The bone density study population comprised 658 patients (47% of all US patients) [Fig 1]. All treatment groups were similar with respect to age, gender, FEV1, BMI, and the number of exacerbations treated with antibiotics and/or OCSs or requiring hospitalization in the prior year. Patient activity levels, as estimated by SGRQ activity score, and the number of patients receiving ICSs, OCSs, bisphosphonates, or other BMD medications (calcium, vitamin D, or hormone replacement therapy) recorded at
Discussion
The TORCH study is the first to prospectively investigate the long-term safety of therapy with an ICS in combination with an inhaled LABA and either component alone with respect to BMD in patients with COPD. There were three important findings in the study. First, the prevalence of osteoporosis and osteopenia in patients with COPD is very high, irrespective of gender. Second, no statistically or clinically significant differences in BMD or fractures were observed between placebo and any of the
Conclusions
We observed a high prevalence of osteopenia and osteoporosis in men and women with COPD. It is important to remain aware of these potentially treatable conditions. Although safety concerns remain paramount in the care of patients with COPD, the results of the TORCH study are reassuring as we did not detect that either SFC or its individual components had a significant effect on BMD compared with placebo over 3 years.
Acknowledgments
Author contributions: The TORCH Steering Committee, comprising six academics and three representatives of the sponsor, developed the design and concept, approved the statistical plan, had full access to and interpreted the data, wrote the article, and was responsible for decisions with regard to publication. Dr. Ferguson served as the primary author, reviewing all data, and wrote the article. Dr. Calverley developed the study protocol, was a study investigator, interpreted study data,
References (0)
Cited by (218)
Update on guidelines for the treatment of COPD in Taiwan using evidence and GRADE system-based recommendations
2021, Journal of the Formosan Medical AssociationInhaled Corticosteroids in Chronic Obstructive Pulmonary Disease: Benefits and Risks
2020, Clinics in Chest MedicineEpidemiology of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease in Taiwan
2024, Journal of Epidemiology and Global HealthInhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease
2023, Cochrane Database of Systematic Reviews
Funding/Support: Supported by GlaxoSmithKline grant No. SCO30003.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).