Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease
Zorica Ciric, Ivana Stankovic, Tatjana Pejcic, Lidija Ristic, Milan Rancic, Milan Radovic
Med Arh. 2012; 66(6): 385-387
One of the extrapulmonary effects of chronic obstructive pulmonary disease (COPD) is osteoporosis. Osteoporosis is characterized by a low bone mineral density (BMD). The aim: The aim of this study was to determine relationship between bone mineral density and severity of COPD and body mass index (BMI). Patients and methods: in this study 85 COPD patients were recruited. Diagnosis and severity of COPD was made according to the GOLD guidelines. Height and weight were measured, and BMI was calculated. BMD (at the lumbar spine and at the femoral neck) were performed using Dual energy X-ray absorptiometry (DXA). BMD was expressed in g/cm2 and standardized T-score. Results: The increase of COPD severity leads to the decrease of average values of BMD (femoral neck p =0,005; lumbar spine p=0,026), as well as T score (femoral neck p =0,026; lumbar spine =0,156). Also, the decrease of BMI leads to the decrease of average values of BMD (femoral neck p=0,034; lumbar spine p=0,269) and T score (femoral neck p=0,001; lumbar spine p=0,105), as well as to the increase of total osteoporosis (p=0,009). Conclusion: patients with severe COPD and lowe BMI have lower BMD and T score and more frequently have osteoporosis.
1. Global Initiative For Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Menagement, and Prevention of Chronic Obstructive Pulmonary Disease (Updated 2010.)
2. Agusti AG. Systemic effects of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005; 2: 367–370.
3. Decramer M, Rennard S, Troosters T, et al . COPD as a lung disease with systemic consequences—clinical impact, mechanisms, and potential for early intervention . COPD . 2008; 5 (4) : 235–256 .
4. Sabit R, Bolton CE, Edwards PH, et al. Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007; 175: 1259–1265.
5. Hardy R, Cooper MS . Bone loss in inflammatory disorders . J Endocrinol . 2009; 201 (3) : 309 – 320.
6. Kanis JA, Johansson H, Oden A, Johnell O, De Laet C, Melton III LJ, et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 2004;19:893–9.
7. Biskobing DM. COPD and osteoporosis. Chest. 2002; 121: 609–620.
8. WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and Management of Osteoporosis: report of a WHO scientific group. Available at http://whqlibdoc.who.int/trs/WHO_TRS_921.pdf. 2007.
9. Nikolic M. Održavanje telesne mase. U Nikolic M, urednik. Dijetetika. Niš: Medicinski fakultet Univerziteta u Nišu&WUS Austria; 2008. pp.115-131.
10. Kjensli A, Mowinckel P, Ryg MS, et al. Low bone mineral density is related to severity of chronic obstructive pulmonary disease. Bone. 2007; 40: 493–497.
11. Jorgensen NR, Schwarz P. Osteoporosis in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med. 2008; 14:122-127.
12. Watz H, Waschki B, Boehme C, et al. Extrapulmonary effects of chronic pulmonary disease on physical activity: a cross-sectional study. Am J Respir Crit Care Med. 2008; 177: 743–751.
13. van Staa TP , Leufkens HG , Cooper C . The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis . Osteoporos Int . 2002 ; 13 (10): 777–787 .
14. Langhammer A, Forsmo S, Syversen U . Long-term therapy in COPD: any evidence of adverse effect on bone? Int J Chron Obstruct Pulmon Dis . 2009; 4 (4) : 365–380 .
15. Bolton CE, Ionescu AA, Shiels KM, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004; 170: 1286–1293.
16. Vrieze A, de Greef MH, Wijkstra PJ, et al. Low bone mineral density in COPD patients related to worse lung function, low weight and decreased fat-free mass. Osteoporos Int. 2007; 18: 1197–1202.
17. Kaplan A. Co-morbidities in people with COPD: a result of multiple diseases, or multiple manifestations of smoking and reactive inflammation? Prim Care Respir J. 2008; 17:1 99–205.
18. Lehouck A, Boonen S, Decramer M, Janssens W. COPD, bone metabolism and osteoporosis. Chest. 2011; 139: 648-657.