nach oben

Erschienen in:

01.11.2009 | Original Article

Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D

verfasst von: C. B. Franco, G. Paz-Filho, P. E. Gomes, V. B. Nascimento, C. A. M. Kulak, C. L. Boguszewski, V. Z. C. Borba

Erschienen in: Osteoporosis International | Ausgabe 11/2009

Einloggen, um Zugang zu erhalten

Abstract

Summary

We did a cross-sectional analysis of chronic pulmonary obstructive disease (COPD) patients without chronic use of systemic glucocorticoids (CUG). Osteoporosis was found in 51% and bone mineral density (BMD) was correlated with severity of disease. Low levels of vitamin D were found in 94%. All COPD patients may benefit from vitamin D supplementation and screening for low BMD.

Introduction

Patients with chronic pulmonary obstructive disease have low bone mineral density, caused by chronic use of systemic glucocorticoids and hypovitaminosis D. However, patients without CUG may also have low BMD.

Methods

We performed a cross-sectional analysis in 49 patients (21 men, 28 postmenopausal women), with COPD without CUG, from Brazil (25° 25' S). Several markers of bone metabolism were measured, plus BMD. Osteoporosis risk factors and history of fractures were investigated. Respiratory function was assessed by venous gasometry, spirometry, and oximetry. BMD results were compared to those of 40 healthy non-smokers controls.

Results

COPD patients had lower BMD at all sites (p < 0.01). Osteoporosis was observed in 51%. BMD independently correlated with stage of disease (lumbar spine, R = 0.38, p = 0.01; total femur, R = 0.36, p = 0.01; femoral neck, R = 0.40, p < 0.01). Ninety-four percent had low levels of vitamin D (<30 ng/mL) and 67% had secondary hyperparathyroidism. Vitamin D was correlated with oxygen saturation (R = 0.36, p = 0.01), with lower levels in those with saturation <88% (p = 0.01).

Conclusion

Patients with COPD without CUG have increased risk for osteoporosis. Such patients have hypovitaminosis D, which is correlated with the severity of disease. Screening for low BMD and vitamin D supplementation may be warranted to all COPD patients.

Biskobing DM (2002) COPD and osteoporosis. Chest 121(2):609–620CrossRefPubMed

Iqbal F, Michaelson J, Thaler L et al (1999) Declining bone mass in men with chronic pulmonary disease: contribution of glucocorticoid treatment, body mass index, and gonadal function. Chest 116(6):1616–1624CrossRefPubMed

Jorgensen NR, Schwarz P (2008) Osteoporosis in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med 14(2):122–127CrossRefPubMed

Kanis JA, Johansson H, Oden A et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19(6):893–899CrossRefPubMed

McEvoy CE, Ensrud KE, Bender E et al (1998) Association between corticosteroid use and vertebral fractures in older men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157(3 Pt 1):704–709PubMed

Vrieze A, de Greef MH, Wijkstra PJ, Wempe JB (2007) Low bone mineral density in COPD patients related to worse lung function, low weight and decreased fat-free mass. Osteoporos Int 18(9):1197–1202CrossRefPubMed

Incalzi RA, Caradonna P, Ranieri P et al (2000) Correlates of osteoporosis in chronic obstructive pulmonary disease. Respir Med 94(11):1079–1084CrossRefPubMed

Papaioannou A, Parkinson W, Ferko N et al (2003) Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada. Osteoporos Int 14(11):913–917CrossRefPubMed

Karadag F, Cildag O, Yurekli Y, Gurgey O (2003) Should COPD patients be routinely evaluated for bone mineral density? J Bone Miner Metab 21(4):242–246PubMed

10.

Fabbri LM, Hurd SS (2003) Global strategy for the diagnosis, management and prevention of COPD: 2003 update. Eur Respir J 22(1):1–2CrossRefPubMed

11.

Dubois EF, Roder E, Dekhuijzen PN et al (2002) Dual energy X-ray absorptiometry outcomes in male COPD patients after treatment with different glucocorticoid regimens. Chest 121(5):1456–1463CrossRefPubMed

12.

NCAAA. Task Force on Recommended Alcohol Questions—National Council on Alcohol Abuse and Alcoholism Recommended Sets of Alcohol Consumption Questions 2003 [cited 2008 September 15]; Available from:

13.

Lolio C, Souza J, Santo A, Buchalla C (1993) Prevalence of smoking in a city of southeastern Brazil. Rev Saúde Pública 27:4

14.

Lloyd T, Rollings N, Eggli DF et al (1997) Dietary caffeine intake and bone status of postmenopausal women. Am J Clin Nutr 65(6):1826–1830PubMed

15.

Expert Panel Report 3 (EPR-3) (2007) Guidelines for the diagnosis and management of asthma—summary report 2007. J Allergy Clin Immunol 120(5 Suppl):S94–S138

16.

Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281CrossRefPubMed

17.

Hans D, Downs RW Jr, Duboeuf F et al (2006) Skeletal sites for osteoporosis diagnosis: the 2005 ISCD Official Positions. J Clin Densitom 9(1):15–21CrossRefPubMed

18.

Knudson RJ, Slatin RC, Lebowitz MD, Burrows B (1976) The maximal expiratory flow-volume curves normal standards variability and effect of age. Am Rev Respir Dis 113:587–600PubMed

19.

Standardization of Spirometry (1995) 1994 Update. American Thoracic Society. Am J Respir Crit Care Med 152(3):1107–1136

20.

Jorgensen NR, Schwarz P, Holme I et al (2007) The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study. Respir Med 101(1):177–185CrossRefPubMed

21.

Katsura H, Kida K (2002) A comparison of bone mineral density in elderly female patients with COPD and bronchial asthma. Chest 122(6):1949–1955CrossRefPubMed

22.

Forli L, Halse J, Haug E et al (2004) Vitamin D deficiency, bone mineral density and weight in patients with advanced pulmonary disease. J Intern Med 256(1):56–62CrossRefPubMed

23.

Kjensli A, Mowinckel P, Ryg MS, Falch JA (2007) Low bone mineral density is related to severity of chronic obstructive pulmonary disease. Bone 40(2):493–497CrossRefPubMed

24.

Lekamwasam S, Trivedi DP, Khaw KT (2002) An association between respiratory function and bone mineral density in women from the general community: a cross sectional study. Osteoporos Int 13(9):710–715CrossRefPubMed

25.

Lekamwasam S, Trivedi DP, Khaw KT (2005) An association between respiratory function and hip bone mineral density in older men: a cross-sectional study. Osteoporos Int 16(2):204–207CrossRefPubMed

26.

Sin DD, Man JP, Man SF (2003) The risk of osteoporosis in Caucasian men and women with obstructive airways disease. Am J Med 114(1):10–14CrossRefPubMed

27.

Riancho JA, Gonzalez Macias J, Del Arco C et al (1987) Vertebral compression fractures and mineral metabolism in chronic obstructive lung disease. Thorax 42(12):962–966CrossRefPubMed

28.

Goldstein MF, Fallon JJ Jr, Harning R (1999) Chronic glucocorticoid therapy-induced osteoporosis in patients with obstructive lung disease. Chest 116(6):1733–1749CrossRefPubMed

29.

de Vries F, van Staa TP, Bracke MS et al (2005) Severity of obstructive airway disease and risk of osteoporotic fracture. Eur Respir J 25(5):879–884CrossRefPubMed

30.

Elmstahl S, Ekstrom H, Johnell O et al (2006) No association between inhaled corticosteroids and whole body DXA in postmenopausal women. Pharmacoepidemiol Drug Saf 15(7):527–535CrossRefPubMed

31.

Halpern MT, Schmier JK, Van Kerkhove MD et al (2004) Impact of long-term inhaled corticosteroid therapy on bone mineral density: results of a meta-analysis. Ann Allergy Asthma Immunol 92(2):201–207 quiz 7-8, 67PubMedCrossRef

32.

Jones AM, Munavvar M, Vail A et al (2002) Prospective, placebo-controlled trial of 5 vs 10 days of oral prednisolone in acute adult asthma. Respir Med 96(11):950–954CrossRefPubMed

33.

Richy F, Bousquet J, Ehrlich GE et al (2003) Inhaled corticosteroids effects on bone in asthmatic and COPD patients: a quantitative systematic review. Osteoporos Int 14(3):179–190PubMed

34.

Bandeira F, Griz L, Dreyer P et al (2006) Vitamin D deficiency: a global perspective. Arq Bras Endocrinol Metabol 50(4):640–646PubMed

35.

Saraiva GL, Cendoroglo MS, Ramos LR et al (2005) Influence of ultraviolet radiation on the production of 25 hydroxyvitamin D in the elderly population in the city of Sao Paulo (23 degrees 34'S), Brazil. Osteoporos Int 16(12):1649–1654CrossRefPubMed

36.

Dimai HP, Domej W, Leb G, Lau KH (2001) Bone loss in patients with untreated chronic obstructive pulmonary disease is mediated by an increase in bone resorption associated with hypercapnia. J Bone Miner Res 16(11):2132–2141CrossRefPubMed

37.

Donovan DS Jr, Papadopoulos A, Staron RB et al (1998) Bone mass and vitamin D deficiency in adults with advanced cystic fibrosis lung disease. Am J Respir Crit Care Med 157(6 Pt 1):1892–1899PubMed

38.

Sutherland ER, Cherniack RM (2004) Management of chronic obstructive pulmonary disease. N Engl J Med 350(26):2689–2697CrossRefPubMed

39.

Black PN, Scragg R (2005) Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey. Chest 128(6):3792–3798CrossRefPubMed

40.

Melamed ML, Michos ED, Post W, Astor B (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168(15):1629–1637CrossRefPubMed

41.

Thomas MK, Lloyd-Jones DM, Thadhani RI et al (1998) Hypovitaminosis D in medical inpatients. N Engl J Med 338(12):777–783CrossRefPubMed

42.

Gerdhem P, Obrant KJ (2002) Effects of cigarette-smoking on bone mass as assessed by dual-energy X-ray absorptiometry and ultrasound. Osteoporos Int 13(12):932–936CrossRefPubMed

43.

Law MR, Hackshaw AK (1997) A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ 315(7112):841–846PubMed

44.

Szulc P, Garnero P, Claustrat B et al (2002) Increased bone resorption in moderate smokers with low body weight: the Minos study. J Clin Endocrinol Metab 87(2):666–674CrossRefPubMed

45.

Ward KD, Klesges RC (2001) A meta-analysis of the effects of cigarette smoking on bone mineral density. Calcif Tissue Int 68(5):259–270CrossRefPubMed

Titel: Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D
verfasst von: C. B. Franco
G. Paz-Filho
P. E. Gomes
V. B. Nascimento
C. A. M. Kulak
C. L. Boguszewski
V. Z. C. Borba
Publikationsdatum: 01.11.2009
Verlag: Springer-Verlag
Erschienen in: Osteoporosis International / Ausgabe 11/2009
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-009-0890-5

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärzte und Psychotherapeuten.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders scheint das auf weibliche Kranke zuzutreffen, wie eine Studie zeigt.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D