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The effect of cyclooxygenase-2 inhibitors on bone mineral density: results from the Canadian Multicentre Osteoporosis Study

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Abstract

Introduction

The use of cyclooxygenase-2 (COX-2) inhibitors has been demonstrated to not only impair load-induced bone formation but also prevent menopause-associated bone loss. We hypothesized that COX-2 inhibitor use would be associated with increased bone mineral density (BMD) in postmenopausal women not using estrogen therapy and, conversely, with decreased BMD in men.

Methods

The Canadian Multicentre Osteoporosis Study is a longitudinal, randomly selected, population-based community cohort. We present data from men (n=2,004) and postmenopausal women age 65 and older (n=2,776) who underwent a BMD measurement and structured interview in the 5th year of the study. The outcome measure was percent difference in BMD (g/cm2).

Results

Daily COX-2 inhibitor use was reported by 394 subjects. In men, daily use of COX-2 inhibitors was associated with a lower BMD at all hip sites, with a percent difference of −3.1% [95% confidence interval (CI), −6.0, −0.3] between users and nonusers at total hip. In postmenopausal women not using estrogen replacement therapy, daily COX-2 inhibitor use was associated with higher BMD at most sites [percent difference at total hip: +3.0% (95% CI, 0.3, 5.8)]. These effects appeared to be dose-dependent.

Conclusion

COX-2 inhibitor use was associated with a lower BMD in men and, on the other hand, with a higher BMD in postmenopausal women not using estrogen replacement therapy. Men who have used COX-2 inhibitors may wish to seek BMD measurement to assess their fracture risk. However, COX-2 inhibitors may have utility in postmenopausal women if bone-selective analogs can be developed.

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Acknowledgements

The authors wish to acknowledge the assistance of Claudie Berger and Cristine Leroux with data management and the assistance of Dr. Suzanne Morin with data analysis.

Investigators for the CaMos Study Group:

CaMos Coordinating Centre, McGill University, Montreal, Quebec: David Goltzman (co-principal investigator), Nancy Kreiger (co-principal investigator), Alan Tenenhouse (senior researcher), Suzette Poliquin (national coordinator), Suzanne Godmaire (research assistant), Claudie Berger (study statistician), Lawrence Joseph (former study statistician).

Memorial University, St. John’s Newfoundland: Carol Joyce (director), Emma Sheppard (coordinator).

Dalhousie University, Halifax, Nova Scotia: Susan Kirkland, Stephanie Kaiser (codirectors), Barbara Stanfield (coordinator).

Laval University, Quebec City, Quebec: Jacques P. Brown (director), Louis Bessette (co-director), Evelyne Lejeune (coordinator), Marc Gendreau (Imaging Coordinator).

Queen’s University, Kingston, Ontario: Tassos Anastassiades (director), Tanveer Towheed (co-director), Barbara Matthews (coordinator).

University of Toronto, Toronto, Ontario: Bob Josse (director), Tim Murray (co-director), Barbara Gardner-Bray (coordinator).

McMaster University, Hamilton, Ontario: Jonathan D. Adachi (director), Alexandra Papaioannou (co-director), Laura Pickard (coordinator).

University of Saskatchewan, Saskatoon, Saskatchewan: Wojciech P. Olszynski (director), Jola Thingvold (coordinator).

University of Calgary, Calgary, Alberta: David A. Hanley (director), Jane Allan (coordinator).

University of British Columbia, Vancouver, British Columbia: Jerilynn C. Prior (director), Yvette Vigna (coordinator).

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

    J. B. Richards & L. Joseph

  2. Division of Endocrinology, Department of Medicine, McGill University, Montreal, Quebec, Canada

    J. B. Richards & D. Goltzman

  3. Respiratory Division and Respiratory Epidemiology Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada

    K. Schwartzman

  4. Department of Public Health Sciences, University of Toronto, Toronto, Canada

    N. Kreiger

  5. Professor Emeritus, McGill University, Montreal, Quebec, Canada

    A. Tenenhouse

  6. Bone and Calcium Research Laboratories, Royal Victoria Hospital, Rm H467, 687 Pine Ave., Montreal, PQ, H3Y 2W3, Canada

    D. Goltzman

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  1. J. B. Richards
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  2. L. Joseph
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For the Canadian Multicentre Osteoporosis Study (CaMos)

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Correspondence to D. Goltzman.

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Richards, J.B., Joseph, L., Schwartzman, K. et al. The effect of cyclooxygenase-2 inhibitors on bone mineral density: results from the Canadian Multicentre Osteoporosis Study. Osteoporos Int 17, 1410–1419 (2006). https://doi.org/10.1007/s00198-006-0142-x

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  • DOI: https://doi.org/10.1007/s00198-006-0142-x

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