Osteoporosis In Chronic Obstructive Pulmonary Disease Patients Research Articles

Managing osteoporosis in COPD.

Chronic obstructive pulmonary disease (COPD) is a serious respiratory disease with high morbidity, disability and mortality worldwide. Every year, many people die from the disease or its comorbidities. Osteoporosis is a common complication of COPD, which can lead to increased fractures in COPD patients, aggravate the disease, and then bring great pain and burden to patients. The possible factors leading to osteoporosis in COPD patients include systemic inflammation, corticosteroid use, vitamin D deficiency, physical inactivity, tobacco exposure, lower bone mineral density, hypogonadism, hypoxia, and anemia. In clinical practice, the rate of diagnosis and treatment of osteoporosis in patients with COPD is low. Several studies demonstrated that treating osteoporosis with bisphosphonates could improve bone density, make breathing easier, and improve the quality of life of COPD patients. However, no studies have examined the effect of anti-osteoporosis therapy on fracture prevention in COPD patients. More research is needed to clarify how to implement holistic medical interventions in COPD patients with osteoporosis. We recommend that every COPD patient be screened for osteoporosis and treated with standard medications for primary osteoporosis.

Prevalence and Associated Factors of Osteoporosis in Chronic Obstructive Pulmonary Disease Patients

Background: Chronic Obstructive Pulmonary Disease (COPD) is a lifestyle-related chronic inflammatory pulmonary disease and a major cause of morbidity and mortality globally. In this study, we evaluated the prevalence and associated factors of osteopenia and osteoporosis in COPD patients.
 Methods:A total of 91 COPD patients were recruited from October 2017 and December 2018. Lung function test, CAT score, 6-minutes’ walk test, Modified Medical Research Council (MMRC) dyspnea score and body mass index, air flow obstruction, dyspnea, and exercise capacity (BODE index) were evaluated in the patients. Bone Mineral Density (BMD) measurements of the femoral neck, total femur (including femoral neck, trochanter, and intertrochanter area), and lumbar spine were conducted using dual-energy X-ray absorptiometry. A T-score which was 2.5 standard deviations (SDs) below the average value was indicative of osteoporosis, in accordance with the World Health Organization criteria. We excluded COPD patients who had asthma, malignancy, and fracture.
 Results: There were 86 males (mean age ± SD: 66.49±9.40 years) and 5 females (mean age±SD: 65.40±12.40 years). Among all the patients, 46 (51.1 %) patients had osteopenia and 36 (40 %) had osteoporosis. Comparing COPD grades showed grade 2 was a more prevalent grade (41.1 %). There was no statistically association between femoral neck T score (mean±SD: -2.21±0.89) and COPD grade (P= 0.58), while lumber spine T score (mean±SD: -2.13±1.11) was statistically decreased with increasing severity of COPD (p= 0.02).
 Conclusion: The results of our study demonstrated that osteoporosis is common among COPD patients. Moreover, we found significant correlations between BMI, walking test, FEV1, MMRC, and BODE index.

Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review.

Osteoporosis is a highly prevalent condition affecting a growing number of patients affected by chronic obstructive pulmonary disease (COPD), with crucial implications for risk of fragility fractures, hospitalization, and mortality. Several risk factors have been identified to have a role in osteoporosis development in COPD patients, including corticosteroid therapy, systemic inflammation, smoke, physical activity levels, malnutrition, and sarcopenia. In this scenario, a personalized multitarget intervention focusing on the pathological mechanisms underpinning osteoporosis is mandatory to improve bone health in these frail patients. Specifically, physical exercise, nutritional approach, dietary supplements, and smoke cessation are the cornerstone of the lifestyle approach to osteoporosis in COPD patients, improving not only bone health but also physical performance and balance. On the other hand, pharmacological treatment should be considered for both the prevention and treatment of osteoporosis in patients at higher risk of fragility fractures. Despite these considerations, several barriers still affect the integration of a personalized approach to managing osteoporosis in COPD patients. However, digital innovation solutions and telemedicine might have a role in optimizing sustainable networking between hospital assistance and community settings to improve bone health and reduce sanitary costs of the long-term management of COPD patients with osteoporosis.

Low bone mineral density and chronic obstructive pulmonary disease – A missed correlation

Chronic obstructive pulmonary disease (COPD) is a disorder involving various other systems in the body apart from lungs. Such co-existence leads to worsening of disease control and associated increase in the morbidity as well as mortality of the diseased patients. They COPD patients are more prone for association with low fat free mass and low bone mineral density owing to pronounced persistent inflammation and various other associated risk factors. Low bone mineral density in those patients lead to the development of osteoporosis in those patients. Osteoporosis also worsens COPD and reduce their symptom free survival and reduction in day-to-day activities. However, the occurrence of osteoporosis in COPD patients is not well represented. The main objective is to study the occurrence of low bone mineral density leading to osteoporosis and osteopenia in COPD individuals and to propose various risk Factors leading to its development. This cross-sectional prevalence study was done in a tertiary care hospital in the department of Respiratory medicine over a period of 2 years. 100 diagnosed patients of COPD by spirometry (FEV/FVC < 0.70) according to GOLD guidelines were included in the study. Spirometry was done to group the patients in various grades of airflow obstruction severity and DXA scan of lumbar spine was done with the help of bone densitometer to determine the T-scores and to look for the presence of any reduction in Bone Mineral Density (BMI) satisfying WHO osteoporosis diagnostic guidelines. Among the 100 patients of COPD, 52 patients (52%) had osteoporosis and 22 patients (22%) had osteopenia. Majority of the patients (96.1%) who had osteoporosis were confined to stages 3 and 4 GOLD grading of severity of airflow obstruction. Patients in stages III and IV of airflow obstruction severity were found to have reduction in their bone mineral density. Underweight COPD patients were found to have higher cases of osteoporosis. On analysis; female sex, severe degree of airflow obstruction, Underweight, intake of higher doses of inhalational and oral or systemic corticosteroids, frequent exacerbations and deficiency of 1,25-Dihydrocholecalciferol were observed as risk factors for osteoporosis in COPD patients. In this study, the prevalence of osteoporosis and osteopenia were 52% and 22% respectively in the COPD patients. The risk of acquiring osteoporosis increased with the airflow obstruction severity. Thus, a high index of clinical suspicion and early diagnosis of it is essential to evaluate for osteoporosis in COPD and to treat it early to prevent further disability, morbidity and mortality and to improve the quality of life in COPD patients.

To Study the Prevalence of Osteopenia and Osteoporosis in Patients with COPD and to Correlate Severity of COPD with Prevalence of Osteopenia and Osteoporosis

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory airway disease characterized by both pulmonary and systemic inflammatory response and associated extra-pulmonary complications. Female gender, age and smoking are common pathogenic risk factors for both COPD and osteoporosis. Many other factors like low daily physical activity, chronic malnutrition, hypogonadism, vitamin D deficiency and chronic steroid therapy are risk factors for osteoporosis. Objectives: The study was done to evaluate the prevalence of osteopenia and osteoporosis in patients of COPD and to correlate the severity of COPD with osteopenia/ osteoporosis. Material & Method: The study was conducted at a tertiary care hospital in Delhi after ethical clearance from institutional review board. Total of 76 patients of both genders were taken. COPD diagnosis and staging was done as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Bone mineral density (BMD) was evaluated by DEXA scan in all patients. All data was entered in preformed data sheets. Statistical analysis for association of COPD with osteoporosis was done by chi-square test. Result: Mostly patients were having either osteopenia or osteoporosis, only 6% patients were having normal BMD. COPD stage III-IV were having significant bone mass loss. Those having long smoking history were more osteoporotic as compared to others. Conclusion: There is a very high prevalence of osteopenia and osteoporosis in COPD patients especially those with prolonged smoking history, GOLD stage III-IV. 35.5% of COPD patients had osteopenia and 57.9 % had osteoporosis.

Osteoporosis in Chronic Obstructive Pulmonary Disease: More than just a Comorbidity

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality and loss of Disability-Adjusted Life-Years (DALYs) worldwide. It often is accompanied by the presence of various systemic comorbidities including osteoporosis which may have an impact on the course of the disease. Osteopenia and osteoporosis are the consequences of loss of Bone Mineral Density (BMD) and have been widely known major comorbidities in COPD patients. Female sex, age, and smoking are common pathogenic factors for both COPD and osteoporosis, other factors such as reduced daily physical activity, malnutrition, low body mass index, hypogonadism, vitamin D deficiency, chronic renal insufficiency, chronic hypoxemia, and drugs like corticosteroids, have been invoked to explain such a frequent association between them. Osteoporosis in COPD is however often undertreated. It has been shown in recent studies that both decreased Bone Mineral Density (BMD) and impaired bone quality contribute to bone fragility, causing fractures in COPD patients. Pulmonary function and activities of the daily life of COPD patients may be further deteriorated by osteoporosis-associated fractures. Calcium and vitamin D, hormone replacement when indicated, calcitonin, and bisphosphonate administration are few effective strategies to tackle bone loss and osteoporosis. Awareness about this high prevalence of osteoporosis in COPD patients is critically important and physicians should look for such fracture risks. Routine screening and early diagnosis of osteoporosis will enable physicians to provide the appropriate treatment to prevent fracture, which leads to improved quality of life as well as better long-term prognosis.

COPD and Osteoporosis: Associated Factors in Patients Treated with Inhaled Corticosteroids.

PurposeOsteoporosis is a systemic skeletal disease with a consequent increase in fractures rates. Osteoporosis may be primary which is related with normal aging, or secondary which occurs in the presence of an underlying disease or medication. Osteoporosis is one of the significant comorbidities in chronic obstructive pulmonary disease (COPD). In this study, we aimed to investigate the presence of osteoporosis and the influencing factors in COPD patients.Patients and MethodsThis is a two-group comparison study that was conducted among 30 COPD patients on inhaled corticosteroid (ICS) and 33 controls. It was conducted in the outpatient clinics at the Departments of Physical Medicine and Rehabilitation and Pulmonary Diseases in Bursa Uludag University Hospital, a tertiary reference center, in the northwest region of Turkey. For both groups, demographic variables, osteoporosis risk questioning, body mass index (BMI), bone mineral density (BMD), biochemical blood tests, vertebral fractures on lumbar and thoracic x-rays were recorded. COPD patients were also evaluated for lung functions via spirometry.ResultsThirty patients with COPD (Group 1) and 33 controls (Group 2) were included in the study. Comparing the demographic and biochemical data, no difference was found between the groups except smoking (pack/year) (p<0.001) and erythrocyte sedimentation rate (p<0.001), which were significantly high in COPD group. BMD in the COPD group was significantly lower in both hip and lumbar regions compared with the controls. There were significant correlations between L2 BMD values and pulmonary function tests. BMI was significantly low in osteoporotic COPD patients when compared with the non-osteoporotic COPD patients (p=0.002).ConclusionIn patients with COPD using inhaled corticosteroids, BMD was significantly low compared with the controls. Osteoporotic COPD patients had significantly lower BMI than non-osteoporotic. These findings suggest that pulmonary dysfunction and low BMI are associated with osteoporosis in COPD patients.

The Impact of Lung Function on Extra-Pulmonary Diseases and All-Cause Mortality in US Adult Population with and without COPD.

ObjectiveSpirometric lung function is usually used to evaluate respiratory health. However, the impact of lung function on extra-pulmonary diseases and all-cause mortality has not been fully elucidated, especially in people without chronic obstructive pulmonary disease (COPD).Patients and MethodsParticipants aged ≥20 and underwent spirometry test from the US National Health and Nutrition Examination Surveys (NHANES) 2007–2012 were analyzed in this study. Multivariate logistic and Cox regressions were used to evaluate the impact of forced expiratory volume in 1 second percent of predicted (FEV1% predicted) and forced vital capacity percent of predicted (FVC% predicted) on 14 extra-pulmonary diseases and all-cause morbidity after adjusting for multiple confounders.ResultsDuring 2007–2012, 1800 COPD patients and 11,437 non-COPD subjects were included. The prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, metabolic syndrome (MS), congestive heart failure (CHF), coronary disease, stroke, chronic kidney disease (CKD), arthritis, cancer, underweight and osteoporosis in COPD patients was higher than that in the non-COPD population. After adjusting for confounders, the decrease of FEV1% predicted and FVC% predicted was related with higher odds of having hypertension, DM, obesity, MS, CHF, coronary disease and depression (OR > 1, P<0.05) in both the COPD and non-COPD populations. These 2 indices were also related with higher odds of dyslipidemia, CKD, arthritis and osteoporosis in the non-COPD population. The risk of stroke, anemia and cancer was not related with the decrease of lung function. In addition, the decrease of lung function was independent risk factors for the increase of all-cause mortality. These risks were gradually increased with the decrease of lung function.ConclusionThe decrease of FEV1% predicted and FVC% predicted was related with higher risk of multiple extra-pulmonary diseases and all-cause mortality in both the COPD and non-COPD population.

The prevalence of osteopenia and osteoporosis in patients with chronic obstructive pulmonary disease and their relation with disease severity

Objective: Osteopenia and osteoporosis are within the systemic features of chronic obstructive pulmonary disease (COPD). The present study aimed to investigate the frequency of osteopenia and osteoporosis in COPD patients and to determine the correlation between bone mineral dansity (BMD) and the clinical characteristics of COPD patients. Method: This retrospective study was conducted in the department of Pulmonary Medicine, at a university hospital in Turkey between January 2014 to August 2016. Data of 92 patients with COPD who underwent dual energy X-ray absorptiometry to evaluate BMD were extracted from the medical records. Osteopenia/osteoporosis was assessed with the T and Z scores. Results: Mean age of the patients was 66.2±9.2 years and males comprised 89.1% of the study group. The frequency of osteopenia/osteoporosis in the COPD patients was 63.0%. Osteopenia/osteoporosis frequency was same in GOLD C/D and GOLD A/B patients [12/19 (%63.1) and 46/73 (%63.1)]. Exacerbation number in the previous year and the readmission rates were higher and the duration of hospital stay of the patients with osteoporosis was longer (p<0.05). A significant positive correlation was noted between body mass index and BMD (r=0.489, p<0.001), BMD and FEV1/FVC (r=0.226, p=0.040), exacerbation number in the previous year (r=-0.429, p=0.001) and the duration of hospital stay in admission (r=-0.228, p=0.034). As the severity of GOLD stage increased, the prevalence of osteopenia was also increased (p trend <0.001). Conclusions: Our data suggest that the prevalence of osteopenia and osteoporosis in COPD patients is high independent of disease stage. Abnormal BMD results are associated with frequent exacerbation, prolongation of hospital stay, and poor course of the disease.

Osteoporosis in Chronic obstructive Pulmonary Disease (COPD) Patients

Background: Osteoporosis is one of the most common systemic features of Chronic obstructive pulmonary disease (COPD). But there had been no data regarding osteoporosis in COPD patients in Bangladesh. Objectives: To determine the frequency of osteoporosis in COPD patients.Materials &amp; Methods: This was a cross sectional observational study. COPD patients were recruited from Sarkari kormachari hospital. Patients were excluded if they had asthma, any disease affecting bones and calcium homeostasis or were receiving drugs related to bone metabolism. Demographic data were collected including age, smoking history, inhaled corticosteroid use, body mass index, treatment history hospital admission. Chest x-ray was done to exclude any infection or malignancy. Blood was obtained for complete blood count, renal function test, CRP. Bone mineral density (BMD; g/cm2) was conducted by using dual energy x-ray absorptiometry scan (DXA scan) at second to fourth lumbar spines (L2-4) and femoral neck.Results: The overall prevalence of osteoporosis according to the lowest T-score at either L2-4 or femoral neck were 56.7%. This is very high than other country. BMI and CRP were significantly associated with osteoporosis.Conclusion: The frequency of osteoporosis in Bangladeshi COPD patients was higher than others. Osteoporosis was associated with low BMI and high level of CRP.J MEDICINE JUL 2018; 19 (2) : 114-118

Risk factors for osteoporosis in male patients with chronic obstructive pulmonary disease in Taiwan.

ObjectiveTo investigate the risk factors for osteoporosis in male Taiwanese patients with chronic obstructive pulmonary disease (COPD).MethodsThis cross-sectional study evaluated male COPD outpatients and age-matched male subjects at a regional teaching hospital. The following data were obtained and analyzed: bone mineral density of the lumbar spine and hip on dual-energy X-ray absorptiometry, demographic characteristics, questionnaire interview results, pulmonary function test results, chest posterior–anterior radiographic findings, and biochemical and high-sensitivity C-reactive protein (hs-CRP) levels.ResultsFifty-nine male COPD patients and 36 age-matched male subjects were enrolled. COPD patients had lower body mass index (BMI) (23.6 ± 4.1 vs. 25.2 ± 3.0 kg/m2) and higher total prevalence for osteoporosis and osteopenia than controls. Among COPD patients, patients with osteoporosis had lower BMI, body weight, waist circumference, and triglyceride level but higher hs-CRP level, and tended to have lower creatinine level. Binary logistic regression analysis for factors including age, BMI, creatinine, hs-CRP, smoking, steroid use, and forced expiratory volume in one second (FEV1) revealed that an hs-CRP level ≥5 and decreased creatinine level were independent risk factors for osteoporosis in COPD patients. Lower BMI tended to be associated with osteoporosis development, although it did not reach statistical significance, and hs-CRP was associated with COPD severity and steroid use history.ConclusionThe total prevalence of osteoporosis and osteopenia in male Taiwanese COPD patients is higher than that in age-matched male subjects and systemic inflammation is an independent risk factors for osteoporosis. Low creatinine level in COPD patients should raise the suspicion of sarcopenia and associated increased risk of osteoporosis.

Assessment of Osteoporosis and Osteopenia and its Co-Relation with Disease Severity in Patients of Chronic Obstructive Pulmonary Disease with Respect to Associated Risk Factors: A Case Control Study in India

Introduction: Chronic obstructive pulmonary disease (COPD) is the major cause of morbidity and mortality which results in an economic and social burden. Osteoporosis is considered as one of the major systemic manifestations of COPD. Aim and Objective: It is to determine the prevalence of osteoporosis in COPD patients and its disease severity and also to evaluate various risk factors involved in reduced bone mineral density in patients with COPD. Methods: A total of 30 COPD patients and 15 healthy controls were enrolled and all individuals were subjected to pulmonary function test and DEXA scan. Various risk factors for COPD associated with osteoporosis and association of osteoporosis with severity of COPD were studied and analyzed. Statistical analysis was done for parametric data using t-test. p value <0.05 was considered as significant.Results: The incidence of osteoporosis was found to be significantly higher in COPD patients (60%) compared to healthy adults (20%) (p=0.017). Osteoporosis within the COPD patients of age group of 51-60 was found to be significantly higher compared to other age group in COPD. Obesity, overweight and smoking habit as well as exacerbations may be the risk factors in COPD patients. The average number of exacerbation in COPD patients was 2.13. COPD Patients in Gold Stage 2 had less osteoporosis while majority of patients in stage 3 and stage 4 had osteoporosis. T score and BMD differed significantly between the cases and control (p=0.007). BMD was higher in healthy controls compared to COPD patients (p=0.012). BMD has higher in age group of 41-50 compared to age group 51-60. (p=0.021).Conclusion: The risk of osteoporosis and osteopenia increases with the increase of COPD severity. There are multiple risk factors which are found to be associated with osteoporosis and osteopenia in COPD. Thus the present study warrants further COPD study.

Prevalence and risk factors of osteoporosis in Chronic Obstructive Pulmonary Disease (COPD) patients from Central India.

The prevalence of osteoporosis in patients with COPD is high and potentially essential. To study prevalence and various risk factors contributing to osteoporosis in COPD patients. The present study is prospective cross sectional study carried out on 80 stable COPD patients attending tertiary care hospital in central India. After taking written consent &amp; detailed clinical history consisting questionnaire about the risk factors, spirometry was done to stage the severity of COPD. DEXA scan of whole body was performed using fan beam X-ray bone densitometer to determine osteoporosis. Chi-square test was used to determine the association between COPD and osteoporosis. Univariate logistic regression was used to analyze the risk factors for developing osteoporosis. In the present study, the overall prevalence of low BMD was found to be 92.5% in COPD patients showing equal prevalence (46.25%) for osteoporosis and osteopenia. The duration &amp; severity of disease along with steroid intake were found to be risk factors of osteoporosis in univariate analysis with risk ratio of 1.32 (95% CI 1.06-1.64), 1.75 (1.11-2.75) and 1.40 (1.00-1.97) respectively (p value &lt;0.05). The prevalence of low BMD was very high in COPD patients at a tertiary care hospital of central India. Duration &amp; severity of disease along with steroid intake were found to be risk factor for osteoporosis in univariate analysis.

Prevalence of Osteoporosis in Korean Patients with Chronic Obstructive Pulmonary Disease and Their Health-related Quality of Life According to the Korea National Health and Nutrition Examination Survey 2008-2011.

BackgroundIn this study, we evaluated the prevalence of osteoporosis, risk factors associated with osteoporosis, and health-related quality of life (HRQOL) in clinically stable chronic obstructive pulmonary disease (COPD) patients.MethodsA total of 1,081 COPD patients were recruited from the Korea National Health and Nutrition Examination Survey (KNHANES) from July 2008 to May 2011. Bone mineral densities at the lumbar spine, femoral neck, and total proximal femur were measured using dual energy X-ray absorptiometry. HRQOL was assessed using the EuroQOL-5 dimensions (EQ-5D) questionnaire. To identify factors associated with osteoporosis and HRQOL in patients with COPD, multivariate regression analyses was performed.ResultsOf the 1,081 COPD patients, 191 (17.7%) were diagnosed with osteoporosis. There were significant differences in age, sex, smoking status, education level, house income, and body mass index (BMI) between the osteoporotic and non-osteoporotic groups. COPD patients with osteoporosis had significantly lower EQ-5D scores than the controls. In multivariate analyses, older age (odds ratio [OR]=1.10, P<0.001) was risk factor for osteoporosis. And patients of male sex (OR=0.06, P<0.001), high house income (OR=0.75, P=0.045), and high BMI (OR=0.74, P<0.001) were less likely to have osteoporosis. In addition, osteoporosis was associated with poor HRQOL (β=−0.21, P=0.023).ConclusionsThe prevalence of osteoporosis in COPD patients based on the 2008 to 2011 KNHANES data were relatively lower than that in physician-diagnosed COPD patients. In these COPD patients, older age, female sex, low household income, and low BMI increased the risk for osteoporosis.

COPD and osteoporosis: links, risks, and treatment challenges.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory airway disease associated with various systemic comorbidities including osteoporosis. Osteoporosis and its related fractures are common and have significant impacts on quality of life and even respiratory function in patients with COPD. COPD-associated osteoporosis is however extremely undertreated. Recent studies have suggested that both decreased bone mineral density (BMD) and impaired bone quality contribute to bone fragility, causing fractures in COPD patients. Various clinical risk factors of osteoporosis in COPD patients, including older age, emaciation, physical inactivity, and vitamin D deficiency, have also been described. It is critically important for pulmonologists to be aware of the high prevalence of osteoporosis in COPD patients and evaluate them for such fracture risks. Routine screening for osteoporosis will enable physicians to diagnose COPD patients with comorbid osteoporosis at an early stage and give them appropriate treatment to prevent fracture, which may lead to improved quality of life as well as better long-term prognosis.

Bone turnover and bone structure in clinical animal models of COPD.

The features of chronic obstructive pulmonary disease(COPD)are chronic inflammatory and emphysema changes in the lungs by long-term cigarette smoke(CS)exposure. Osteoporosis is an important systemic comorbidity of COPD. Severe emphysema and low body mass index(BMI)are independent risk factors for low bone mineral density in COPD patients. However the pathophysiologic mechanisms underlying emphysema and osteoporosis have not been fully elucidated. An established mouse model of CS-induced emphysema with decrease body weight and bone mineral density is important for investigating the cause of osteoporosis in COPD patients.

Prevalence of Osteoporosis and Its Risk Factors in Men with COPD in Qazvin.

Introduction. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Proper diagnosis of osteoporosis as a systemic adverse effect of COPD is of significant importance. The present study aimed at evaluating the prevalence of osteoporosis and its risk factors in men suffering from COPD in Qazvin (2014). Methods. This descriptive-analytical study was conducted on 90 patients with COPD using random sampling. Anthropometric data and results from physical examination were collected. Pulmonary function test and bone mineral densitometry were done for all participants as well. Results. The prevalence of osteopenia and osteoporosis in COPD patients was 31.5 and 52.8 percent, respectively. Bone mineral density (BMD) at the femoral neck was associated significantly with body mass index (BMI), increased severity of COPD, and use of oral corticosteroid (P < 0.05). Conclusion. The results showed that patients' BMI and severity of COPD are two valuable risk factors for osteoporosis screening in COPD patients.

Prevalence of Bone Mineral Density Abnormalities and Factors Affecting Bone Density in Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in Southern India.

Chronic Obstructive Pulmonary Disease (COPD) is a disease of wasting with airflow limitation, associated with a variety of systemic manifestations such as reduced Bone Mineral Density (BMD). There is a paucity of Indian studies on the effects of COPD on BMD. This study was conducted to estimate the prevalence of osteopenia and osteoporosis in COPD patients and the correlation between bone density and severity of COPD classified according to GOLD Global initiative for chronic Obstructive Lung Disease guidelines (GOLD). A prospective study of 60 patients diagnosed to have COPD, was conducted in the outpatient department of Respiratory Medicine, at a tertiary care hospital in Southern India, between September 2012 and September 2013. BMD was measured using ultrasound bone densitometer (ACHILLES GE HEALTH CARE). Patients with a T-score between -1 and -2.5 were considered to be osteopenic while patients with a T score less than -2.5 were considered to be osteoporotic (WHO criteria). Overall, 40 (67%) patients had an abnormal bone mineral density. A total of 21 (35%) patients were osteoporotic while 19 (33%) were osteopenic. BMD levels correlated with severity of obstruction (p<0.001), smoking status (p=0.02), age (p=0.05) and number of pack years (p=0.001). Patients with COPD are at an increased risk for lower BMD and osteoporotic fractures and the risk appears to increase with disease severity. Further studies are required to assess whether routine BMD measurements in COPD patients is beneficial to diagnose osteoporosis and reduce morbidity.

Osteoporosis in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a lifestyle-related chronic inflammatory pulmonary disease associated with significant morbidity and mortality worldwide. COPD is associated with various comorbidities found in all stages of COPD. The comorbidities have significant impact in terms of morbidity, mortality, and economic burden in COPD. Management of comorbidities should be incorporated into the comprehensive management of COPD as this will also have an effect on the outcome in COPD patients. Various comorbidities reported in COPD include cardiovascular disease, skeletal muscle dysfunction, anemia, metabolic syndrome, and osteoporosis. Osteoporosis is a significant comorbidity in COPD patients. Various risk factors, such as tobacco smoking, systemic inflammation, vitamin D deficiency, and the use of oral or inhaled corticosteroids (ICSs) are responsible for its occurrence in patients with COPD. This review will focus on the prevalence, pathogenesis, risk factors, diagnosis, and treatment of osteoporosis in COPD patients.

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

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.