Chest

Chest

Volume 139, Issue 3, March 2011, Pages 648-657
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Recent Advances in Chest Medicine
COPD, Bone Metabolism, and Osteoporosis

https://doi.org/10.1378/chest.10-1427Get rights and content

COPD and osteoporosis are strongly associated because of common risk factors such as age, smoking, and inactivity. In addition, COPD-related systemic inflammation, vitamin D deficiency, and the use of systemic corticosteroids enhance ongoing bone destruction. Osteoporosis, in turn, may cause fragility fractures, which further impair mobility and increase morbidity and mortality. Vertebral compression fractures and rib cage fractures in patients with COPD may also reduce pulmonary function or enhance exacerbations. Early prevention and treatment of osteoporosis in COPD is, therefore, important and should be based on integrated risk assessment tools such as FRAX, which take bone mineral density, history of fragility fractures, and population-specific clinical factors into account. As long as intervention studies focusing on the bone in COPD are lacking, a more rigorous application of existing treatment guidelines of osteoporosis in general is mandatory.

Section snippets

Prevalence of Osteoporosis in COPD

The prevalence of osteoporosis in COPD varies between 4% and 59%, depending on the diagnostic methods used, the population studied, and the severity of the underlying respiratory disease.9 Table 1 summarizes the most important studies. Overall, a higher prevalence of osteoporosis is generally found in patients with COPD when compared with healthy control subjects. In addition, the majority of studies report an increased risk of osteoporosis with lower FEV1.10, 11, 12, 13, 14, 15, 16

Prevalence of Vertebral Compression Fractures in COPD

Several

Pathogenesis of Osteoporosis in COPD

Bone is generally classified into two types. Cortical bone is a dense and strong bone found primarily in the shaft of long bones. Trabecular bone is more porous or weak and typically occurs at the ends of long bones and within the interior of vertebrae and flat bones. Bone tissue is continuously renewed throughout life and it is estimated that in adults, approximately 25% of trabecular bone and 3% of cortical bone is replaced every year. After reaching peak bone mass at the age of 25 to 30

Risk Factors for Osteoporosis in COPD

Apart from important inherent risk factors such as age, female gender, and genetic background, several other factors that may contribute to the development of osteoporosis are potentially amendable for intervention. A recent systematic review examined risk factors for low BMD and bone loss in healthy men aged 50 years or older.43 In addition to a history of fragility fractures and advancing age, consistent evidence was found for smoking, low body weight or weight loss, and physical or

Nonpharmacologic Interventions

Cross-sectional and epidemiologic evidence suggests a strong association between several lifestyle factors in COPD patients and the risk of osteoporotic fragility fractures. Physical inactivity, smoking, and poor diet are accepted as important domains for intervention in COPD patients, and the benefits of multidisciplinary rehabilitation in symptomatic patients have been clearly established.72 However, although several training methods have demonstrated positive effects on bone density in a

Conclusions

Osteoporosis is common in COPD and should be a major concern in the diagnostic and therapeutic approach to COPD patients, who should be regarded as individuals at risk benefiting from osteoporosis assessment and therapy. A clinical guidance to a more aggressive approach is summarized in a flowchart, which integrates risk assessment, diagnosis, and therapeutic interventions (Fig 3). Briefly, early diagnosis is important, even in COPD patients with no symptoms. In this regard, identification of

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

    Funding/Support: This study was supported by the Funds for Scientific Research-Flanders [Grant 059809N] and the Institute for Promotion of Innovation Through Science and Technology-Flanders [Grant 335102].

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