Secondary Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Osteoporosis in patients with broncho-pulmonary pathology is associated with the fact that the inflammatory process has a direct effect on bone metabolism. A large number of pro-inflammatory cytokines, which play an important role in the pathogenesis of obstructive pulmonary diseases, is involved in the regulation of bone resorption. In addition, patients with chronic obstructive pulmonary disease (COPD) of severe and extremely severe degrees, according to GOLD recommendations, receive inhaled glucocorticosteroids (GCS), and in ineffective inhaled GCS-therapy COPD patients are prescribed systemic steroids; that has an undesirable effect on bone marrow state.
 The purpose of the work was to investigate the peculiarities of bone metabolism disorders in patients with COPD. There were examined 26 patients with COPD of the III-IV degrees, groups C and D aged 65.3±3.15 years. Spirography, bone mineral density study were performed; ten-year risk of osteoporotic fractures was evaluated using FRAX; content of calcium, phosphorus, alkaline phosphatase in blood serum were determined.
 As a result of laboratory studies and densitometry, 84.6% of patients were diagnosed osteopenia. The average T-criterion was within (–1.83±0.17) SD (standard deviation) and was significantly lower than in healthy persons (–0.56±0.10) SD, (p<0.001). The degree of reduction of bone mineral density depended on the degree of reduction of FEV1 and COPD degree (r=0.65; p<0.01), as well as on the duration of the disease (r= –0.43; p<0.01). The ten-year risk of osteoporotic fractures in patients with COPD was high and was 5.65%±1.63%, as opposed to 2.13%±0.61% (p<0.001) in practically healthy individuals.
 Thus, severe functional disorders in COPD, a durable anamnesis of the disease contribute to a decrease in bone mineral density and to an increase in the risk of osteoporotic fractures.