Correlates of osteoporosis in chronic obstructive pulmonary disease: An underestimated systemic component

• Published in: Respiratory medicine Vol. 103; no. 8; pp. 1143 - 1151
• Main Authors: Graat-Verboom, Lidwien, Spruit, Martijn A, van den Borne, Ben E.E.M, Smeenk, Frank W.J.M, Martens, Elisabeth J, Lunde, Ragnar, Wouters, Emiel F.M
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.08.2009; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Body composition; Body mass index; Bone densitometry; Bone density; Bone Density - drug effects; Bone Density - physiology; Bone Density Conservation Agents - therapeutic use; Bone Diseases, Metabolic - drug therapy; Bone Diseases, Metabolic - epidemiology; Bone Diseases, Metabolic - etiology; Chronic obstructive pulmonary disease; Cross-Sectional Studies; Diseases of the osteoarticular system; Drug therapy; Female; Forced Expiratory Volume - physiology; Humans; Male; Medical sciences; Middle Aged; Osteopenia; Osteoporosis; Osteoporosis - drug therapy; Osteoporosis - epidemiology; Osteoporosis - etiology; Osteoporosis. Osteomalacia. Paget disease; Pneumology; Prevalence; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary/Respiratory; Regression Analysis; Risk Factors; Screening advice; Studies; Osteoporosis; Screening advice; Chronic obstructive pulmonary disease; Body composition; Osteopenia; Bone densitometry; Lung disease; Respiratory disease; Diseases of the osteoarticular system; Systemic; Medical screening; Bronchus disease; Disseminated; Osteodensitometry; Pneumology
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2009.02.014

Summary Rationale Chronic obstructive pulmonary disease (COPD) patients are at increased risk of osteoporosis. Osteoporosis is under diagnosed and under treated in these patients and the underlying mechanisms remain unclear. To date, screening recommendations for osteoporosis in COPD patients are not available. Objectives To examine the prevalence of drug treatment of bone abnormalities as well as the clinical determinants of osteoporosis in COPD. Methods COPD patients ( n = 554) consecutively entering pulmonary rehabilitation were included in this cross-sectional study. Medical history, current medication use, smoking status, lung function, bone mineral density, body composition and other clinical characteristics were assessed before entering pulmonary rehabilitation. Univariate- and multivariate multinomial logistic regression analyses were used to determine correlates of osteoporosis. Main results Twenty-one percent of patients had osteoporosis and 41% had osteopenia. Osteoporosis was pharmacologically under treated (82% of osteoporotic patients were not receiving bone medication). Independent predictors of osteoporosis were cachexia (OR: 12.1; 95%CI: 4.5–32.7; p < 0.001), age between 55 and 65 years (OR: 6.0; 95%CI: 2.2–16.3; p < 0.001) and over 65 years (OR: 11.7; 95%CI: 4.1–33.1; p = <0.001). Overweight (OR: 0.1; 95%CI: 0.05–0.4; p = 0.001) and obesity (OR: 0.78; 95%CI: 0.02–0.4; p = 0.002) showed a substantial protective effect. Conclusions The majority of COPD patients with osteoporosis entering pulmonary rehabilitation did not receive pharmacological treatment for osteoporosis. Cachectic COPD patients should be screened for osteoporosis, especially when over 55 years of age.