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Prevalence and correlates of osteoporosis in chronic obstructive pulmonary disease patients in India.

Hattiholi J, Gaude GS - Lung India (2014)

Bottom Line: It was also observed that patients with lower body mass index (BMI) had higher prevalence of osteoporosis (37.3%) as compared to overweight patients.In the present study, the prevalence of osteoporosis was 66.6% and another 19.6% had osteopenia.Thus, high clinical suspicion and early diagnosis and treatment is required in the evaluation of osteoporosis in COPD patients so that the quality of life can be improved in these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Karnataka Lingayat Education University, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a syndrome of progressive airflow limitation caused by the abnormal inflammatory reaction of the airway and lung parenchyma. Osteoporosis is one of the major extrapulmonary manifestations of COPD. The, prevalence of osteoporosis in COPD patients in Indian population is unknown.

Objectives: To study the prevalence of osteoporosis in COPD and to define various risk factors associated with reduced bone mineral density (BMD) in COPD.

Materials and methods: The study was done in the department of Pulmonary Medicine of a tertiary care hospital. All the diagnosed cases of COPD according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines were included in this study. The present study was a prospective study in for a period of 1 year. A brief history of the patients was taken, especially regarding duration of illness, number of exacerbations in the past 3 years, smoking in pack years, and history of steroid use (both systemic and inhaled steroids) after which cumulative dose of steroids was calculated. Spirometry was done in all these patients to stage the severity of COPD according to GOLD criteria. DEXA scan of the lumbar spine was done using bone densitometer to determine osteoporosis. A world Health Organization (WHO) criterion for definition of osteoporosis was applied and patients with T-score of > -2.5 standard deviation (SD) were diagnosed to have osteoporosis, -1 SD to -2.5 SD were diagnosed to have osteopenia and < -1 SD as normal. Statistical analysis for association of COPD with osteoporosis was done using chi-square test. Risk factors for osteoporosis were identified by univariate and multivariate logistic regression analysis.

Results: A total of 102 COPD patients were included in the study. Among these, 68 patients (66.6%) had osteoporosis and 20 patients (19.6%) had osteopenia. Majority (64.7%) of the patients who had osteoporosis had stage III and stage IV COPD disease. It was observed that as the severity grade of COPD increased, the risk of osteoporosis also increased. The bone mineral density (BMD) showed a significant difference among different stages of COPD. As the severity of the stage of COPD increased, BMD decreased. It was also observed that patients with lower body mass index (BMI) had higher prevalence of osteoporosis (37.3%) as compared to overweight patients. On univariate analysis, it was observed that risk factors for osteoporosis were female sex, higher number of exacerbations, BMI, and severity of COPD. After using multivariate logistic regression analysis, stage IV COPD (odds ratio (OR): 34.48, 95% confidence interval (CI): 1.59-1,000, P < 0.02), number of acute exacerbations >3 (OR: 30.3, 95% CI: 4.74-200, P < 0.01), and steroid cumulative dose >1,000 mg (OR: 7.35, 95% CI: 0.92-58.5, P < 0.04) were observed to be significant risk factors for osteoporosis in COPD patients.

Conclusions: In the present study, the prevalence of osteoporosis was 66.6% and another 19.6% had osteopenia. As the severity of COPD increased, the risk of osteoporosis increased. GOLD stage III and stage IV patient had significantly lower BMD as compared to stage I and stage II of COPD disease. Stage IV COPD disease, use of oral or parenteral glucocorticoids, and repeated number of exacerbations were found to be independent risk factors for osteoporosis in COPD patients. Thus, high clinical suspicion and early diagnosis and treatment is required in the evaluation of osteoporosis in COPD patients so that the quality of life can be improved in these patients.

No MeSH data available.


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Chronic obstructive pulmonary disease (COPD) related factors for osteoporosis and its functional consequences
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Figure 1: Chronic obstructive pulmonary disease (COPD) related factors for osteoporosis and its functional consequences

Mentions: Other factor which has significant contribution to the development of osteoporosis in COPD is use of parenteral corticosteroids. The above findings can be explained clearly by higher intake of systemic steroids in the group with higher rate of exacerbations. The dose of steroids during exacerbation of COPD is much higher which may contribute in the long run to the higher incidence of reduced BMD. It is also likely that the group having more number of exacerbations is affected by prolonged immobilization. The rising prevalence of glucocorticoid-induced bone loss is so common that the National Osteoporosis Foundation[29] formulated the guidelines regarding these patients and recommended that all patients receiving chronic GC treatment (>1 month) with 7.5 mg/day of prednisone or equivalent should undergo screening for osteoporosis. In the present study, most of the patients with COPD were prescribed steroids during exacerbations and use of steroids may increase with number of exacerbations and hospitalizations. All the patients were categorized as those not on any steroids, those who used only inhaled steroids, those who used <1,000 mg of steroids (cumulative dose; equivalent of prednisolone) and those who used >1,000 mg (cumulative dose; equivalent of prednisolone). Osteoporosis was observed to be high in those using >1,000 mg (cumulative dose, prednisolone) and the association was statistically significant (P < 0.0001). COPD patients on high-dose glucocorticoid therapy exhibit a rapid loss of BMD within the first 6 months.[30] Normal bone metabolism is a result of the equilibrium between bone formation by osteoblasts and bone resorption by osteoclasts. The mechanism of bone loss induced by glucocorticoids is two-fold, with decreased bone formation and increased bone resorption.[31] Similar findings have been observed by Bhattacharya et al., in Indian patients.[12] COPD related risk facts for the development of osteoporosis and its functional consequences are summarized in Figure 1.


Prevalence and correlates of osteoporosis in chronic obstructive pulmonary disease patients in India.

Hattiholi J, Gaude GS - Lung India (2014)

Chronic obstructive pulmonary disease (COPD) related factors for osteoporosis and its functional consequences
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129592&req=5

Figure 1: Chronic obstructive pulmonary disease (COPD) related factors for osteoporosis and its functional consequences
Mentions: Other factor which has significant contribution to the development of osteoporosis in COPD is use of parenteral corticosteroids. The above findings can be explained clearly by higher intake of systemic steroids in the group with higher rate of exacerbations. The dose of steroids during exacerbation of COPD is much higher which may contribute in the long run to the higher incidence of reduced BMD. It is also likely that the group having more number of exacerbations is affected by prolonged immobilization. The rising prevalence of glucocorticoid-induced bone loss is so common that the National Osteoporosis Foundation[29] formulated the guidelines regarding these patients and recommended that all patients receiving chronic GC treatment (>1 month) with 7.5 mg/day of prednisone or equivalent should undergo screening for osteoporosis. In the present study, most of the patients with COPD were prescribed steroids during exacerbations and use of steroids may increase with number of exacerbations and hospitalizations. All the patients were categorized as those not on any steroids, those who used only inhaled steroids, those who used <1,000 mg of steroids (cumulative dose; equivalent of prednisolone) and those who used >1,000 mg (cumulative dose; equivalent of prednisolone). Osteoporosis was observed to be high in those using >1,000 mg (cumulative dose, prednisolone) and the association was statistically significant (P < 0.0001). COPD patients on high-dose glucocorticoid therapy exhibit a rapid loss of BMD within the first 6 months.[30] Normal bone metabolism is a result of the equilibrium between bone formation by osteoblasts and bone resorption by osteoclasts. The mechanism of bone loss induced by glucocorticoids is two-fold, with decreased bone formation and increased bone resorption.[31] Similar findings have been observed by Bhattacharya et al., in Indian patients.[12] COPD related risk facts for the development of osteoporosis and its functional consequences are summarized in Figure 1.

Bottom Line: It was also observed that patients with lower body mass index (BMI) had higher prevalence of osteoporosis (37.3%) as compared to overweight patients.In the present study, the prevalence of osteoporosis was 66.6% and another 19.6% had osteopenia.Thus, high clinical suspicion and early diagnosis and treatment is required in the evaluation of osteoporosis in COPD patients so that the quality of life can be improved in these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Karnataka Lingayat Education University, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a syndrome of progressive airflow limitation caused by the abnormal inflammatory reaction of the airway and lung parenchyma. Osteoporosis is one of the major extrapulmonary manifestations of COPD. The, prevalence of osteoporosis in COPD patients in Indian population is unknown.

Objectives: To study the prevalence of osteoporosis in COPD and to define various risk factors associated with reduced bone mineral density (BMD) in COPD.

Materials and methods: The study was done in the department of Pulmonary Medicine of a tertiary care hospital. All the diagnosed cases of COPD according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines were included in this study. The present study was a prospective study in for a period of 1 year. A brief history of the patients was taken, especially regarding duration of illness, number of exacerbations in the past 3 years, smoking in pack years, and history of steroid use (both systemic and inhaled steroids) after which cumulative dose of steroids was calculated. Spirometry was done in all these patients to stage the severity of COPD according to GOLD criteria. DEXA scan of the lumbar spine was done using bone densitometer to determine osteoporosis. A world Health Organization (WHO) criterion for definition of osteoporosis was applied and patients with T-score of > -2.5 standard deviation (SD) were diagnosed to have osteoporosis, -1 SD to -2.5 SD were diagnosed to have osteopenia and < -1 SD as normal. Statistical analysis for association of COPD with osteoporosis was done using chi-square test. Risk factors for osteoporosis were identified by univariate and multivariate logistic regression analysis.

Results: A total of 102 COPD patients were included in the study. Among these, 68 patients (66.6%) had osteoporosis and 20 patients (19.6%) had osteopenia. Majority (64.7%) of the patients who had osteoporosis had stage III and stage IV COPD disease. It was observed that as the severity grade of COPD increased, the risk of osteoporosis also increased. The bone mineral density (BMD) showed a significant difference among different stages of COPD. As the severity of the stage of COPD increased, BMD decreased. It was also observed that patients with lower body mass index (BMI) had higher prevalence of osteoporosis (37.3%) as compared to overweight patients. On univariate analysis, it was observed that risk factors for osteoporosis were female sex, higher number of exacerbations, BMI, and severity of COPD. After using multivariate logistic regression analysis, stage IV COPD (odds ratio (OR): 34.48, 95% confidence interval (CI): 1.59-1,000, P < 0.02), number of acute exacerbations >3 (OR: 30.3, 95% CI: 4.74-200, P < 0.01), and steroid cumulative dose >1,000 mg (OR: 7.35, 95% CI: 0.92-58.5, P < 0.04) were observed to be significant risk factors for osteoporosis in COPD patients.

Conclusions: In the present study, the prevalence of osteoporosis was 66.6% and another 19.6% had osteopenia. As the severity of COPD increased, the risk of osteoporosis increased. GOLD stage III and stage IV patient had significantly lower BMD as compared to stage I and stage II of COPD disease. Stage IV COPD disease, use of oral or parenteral glucocorticoids, and repeated number of exacerbations were found to be independent risk factors for osteoporosis in COPD patients. Thus, high clinical suspicion and early diagnosis and treatment is required in the evaluation of osteoporosis in COPD patients so that the quality of life can be improved in these patients.

No MeSH data available.


Related in: MedlinePlus