1
|
Shen L, Lv J, Li J, Zhou J, Wang X. Managing Osteoporosis in COPD. Endocr Metab Immune Disord Drug Targets 2024; 24:896-901. [PMID: 37711118 DOI: 10.2174/1871530323666230913105752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 09/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Lilan Shen
- Department of Endocrinology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin 730900, China
| | - Juanqin Lv
- Department of Endocrinology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin 730900, China
| | - Jie Li
- Department of Endocrinology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin 730900, China
| | - Jing Zhou
- Department of Endocrinology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin 730900, China
| | - Xiaomin Wang
- Department of Endocrinology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin 730900, China
| |
Collapse
|
2
|
Jha SS, Kumar M, Agrawal PK, Thakur DK. Osteoporosis in Asthma and COPD. Indian J Orthop 2023; 57:200-208. [PMID: 38107800 PMCID: PMC10721765 DOI: 10.1007/s43465-023-01048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023]
Abstract
Asthma and Chronic Obstructive Pulmonary Disease (COPD) are principally lifestyle related chronic inflammatory airway disease. They are globally associated with various systemic comorbidities and mortality. Osteoporosis is the common associated metabolic bone disease with respiratory disturbances, which affect the prognosis and increase mortality and morbidity in the patients. Apart from OSTEOPOROSIS, exhaustive attention has been paid towards other associated systemic comorbidities like cardiovascular diseases, cerebrovascular diseases, metabolic syndrome, malnutrition, skeletal muscle dysfunction (sarcopenia), anxiety, depression and so on (Iheanacho et al. in Int J Chronic Obstr Pulm Dis 15:439-460, 2020; Singh et al. in Eur Respir J 53:1900164, 2019). Osteoporosis is a significant extrapulmonary manifestation in asthma and COPD, which are grossly neglected and inadequately treated. The comorbidities have significant impact in terms of morbidity, mortality and economic burden in asthma and COPD patients, hence management of asthma and COPD should comprise thorough management, as this will also have an impact on the outcome of these patients. Various risk factors such as smoking, systemic inflammation, vitamin deficiency, and the use of oral or inhaled corticosteroid are responsible for osteoporosis in patients with asthma and COPD. The presence of osteoporosis in patients with asthma and COPD is invariably asymptomatic unless complicated by fragility fractures, therefore, it is necessary to explore the pathogenesis of osteoporosis in asthma and COPD and special attention is to be paid for early recognition of patients at high risk for osteoporosis in these patients. This chapter is focussed on osteoporosis as an extrapulmonary manifestation of asthma and COPD with an emphasis on the pathogenesis, risk factor, potential mechanism of osteoporosis, diagnosis, and prevention with passing reference to treatment as well in asthma and COPD patients.
Collapse
Affiliation(s)
- S. S. Jha
- Department of Orthopaedics, Retired., Nalanda Medical College, Patna, India
- Harishchandra Institute of Orthopaedics and Research, Patna, India
- IOA Orthopaedic Rheumatology Subcommittee (2021–2023), New Delhi, India
- IOA Osteoporosis Subcommittee (2023), New Delhi, India
- Innovative Education and Scientific Research Foundation, New Delhi, India
| | - Mahendra Kumar
- Department of Pulmonary Medicine, Patna Medical College, Patna, India
| | | | | |
Collapse
|
3
|
Kumar S, Bell S. Letter to the editor. Bone 2023; 177:116890. [PMID: 37659440 DOI: 10.1016/j.bone.2023.116890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Shanal Kumar
- Thoracic Department, Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Australia; Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.
| | - Scott Bell
- Thoracic Department, Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| |
Collapse
|
4
|
van Zyl-Smit R, Soin G, Calligaro G. Interstitial lung disease: Does it matter what we call you, or what you look like, or how you behave? Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i2.803. [PMID: 37638141 PMCID: PMC10450450 DOI: 10.7196/ajtccm.2023.v29i2.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Richard van Zyl-Smit
- Division of Pulmonology and Department of Medicine, University of
CapeTown and Groote Schuur Hospital, Cape Town, South Africa
| | - Gurveen Soin
- Division of Rheumatology, Department of Medicine, Stellenbosch
University, Tygerberg Hospital, Cape Town, South Africa
| | - Greg Calligaro
- Division of Pulmonology, Department of Medicine, Groote Schuur
Hospital, Cape Town, South Africa
| |
Collapse
|
5
|
Saadiq Moolla M, Doruyter A, Allwood BW. Bridging the gap: Communicating the results of ventilation: perfusion scans to clinicians. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i2.1231. [PMID: 37638143 PMCID: PMC10450447 DOI: 10.7196/ajtccm.2023.v29i2.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Muhammad Saadiq Moolla
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Alex Doruyter
- NuMeRI Node for Infection Imaging, Central Analytical Facilities, Stellenbosch University, Cape Town, South Africa; Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| |
Collapse
|
6
|
Tran TVM, Li X, Maalouf NM. Bone health outcomes in post-lung transplant patients with cystic fibrosis. J Cyst Fibros 2023; 22:381-387. [PMID: 36669961 DOI: 10.1016/j.jcf.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Osteoporosis is a common comorbidity in patients with cystic fibrosis (CF). Although lung transplantation (LTx) improves quality of life of CF patients, there is little research examining long-term bone health outcomes following LTx in these patients. METHODS Data were collected on 59 patients who underwent LTx between 2006 and 2019, including 30 with CF and 29 without CF. We compared baseline characteristics, long-term bone mineral density (BMD) trends, and fracture incidence between the two patient populations, and examined factors associated with post-LTx fractures in CF patients. RESULTS Compared with non-CF patients, patients with CF were younger, had lower body mass index, and lower baseline BMD Z-scores at the lumbar spine, femoral neck, and total hip (all p<0.001). BMD at all sites declined in both groups in the first year post-LTx. In subsequent years, CF patients exhibited better BMD recovery relative to pre-transplantation, but continued to have lower BMD post-LTx. Post-transplant fractures occurred in 30% and 34% of CF and non-CF patients, respectively. CF patients who developed fractures after LTx had significantly lower BMD and lower pre-transplantation percent predicted forced expiratory volume in one second (FEV1%). CONCLUSIONS Although CF patients exhibit better BMD recovery following LTx compared to their non-CF counterparts, CF patients start with significantly lower pre-LTx BMD and experience a similarly high rate of post-LTx fractures. These findings highlight the unique contribution of the CF disease process to bone health, as well as a clear need for better prevention and treatment of osteoporosis in CF patients before and after LTx.
Collapse
Affiliation(s)
- Triet Vincent M Tran
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Xilong Li
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, United States of America; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Naim M Maalouf
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, United States of America; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America.
| |
Collapse
|
7
|
Grassi G, Cairoli E, Gentile LMS, Chiodini I, Zampogna M, Ghielmetti A, Morlacchi LC, Rossetti V, Rosso L, Righi I, Nosotti M, Arosio M, Blasi F, Eller Vainicher C. Bone Disease in Long-Term Lung Transplant Survivors. Life (Basel) 2023; 13:life13040928. [PMID: 37109457 PMCID: PMC10146054 DOI: 10.3390/life13040928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Background: During the first two years after lung transplantation (LTx), the incidence of fragility fractures (FX) is estimated to be 15–50% and it is lower in patients with cystic fibrosis (CF) as compared with other end-stage lung diseases (nCF). The aim of our study is to compare the skeletal outcomes, after the first 2 years post-LTx, in long-term survivors with CF and nCF. Materials and Methods: We evaluated the FX rate, the changes in bone mineral density (BMD) and trabecular bone score (TBS) in 68 patients (38 CF and 30 nCF) who underwent LTx in our center and with a follow-up after LTx longer than 5 years (7.3 ± 2.0 years). Results: After the second year post-LTx: (i) the FX rate was lower than during the first two years post-LTx (4.4 vs. 20.6%, p = 0.004), with no difference between CF and nCF patients (5.3 vs. 3.3%, p = 0.589); (ii) BMD at lumbar spine, femoral neck and total hip remained stable (−1.6 ± 1.0 vs. −1.4 ± 1.1, p = 0.431, −1.8 ± 0.9 vs. −1.9 ± 0.9, p = 0.683, −1.5 ± 0.9 vs. −1.4 ± 0.9, p = 0.678, respectively) as well as TBS (1.200 ± 0.124 vs. 1.199 ± 0.205, p = 0.166). Conclusions: After the second year post-LTx, the skeletal complications become less frequent and have similar incidence in patients with CF and nCF.
Collapse
Affiliation(s)
- Giorgia Grassi
- Unit of Endocrinology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy
| | - Elisa Cairoli
- Unit for Bone Metabolism Diseases and Diabetes, Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, 20122 Milan, Italy
| | | | - Iacopo Chiodini
- Unit of Endocrinology, Ospedale Niguarda Cà Granda, 20162 Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20123 Milan, Italy
| | - Marta Zampogna
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy
| | - Alberto Ghielmetti
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy
| | - Letizia Corinna Morlacchi
- Respiratory Unit, Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valeria Rossetti
- Respiratory Unit, Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Lorenzo Rosso
- Department of Pathophysiology and Transplantation, University of Milan, 20123 Milan, Italy
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Ilaria Righi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mario Nosotti
- Department of Pathophysiology and Transplantation, University of Milan, 20123 Milan, Italy
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maura Arosio
- Unit of Endocrinology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy
| | - Francesco Blasi
- Respiratory Unit, Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20123 Milan, Italy
| | - Cristina Eller Vainicher
- Unit of Endocrinology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| |
Collapse
|
8
|
Macrae TA, Lazo J, Viduya J, Florez R, Dewey K, Gao Y, Singer JP, Hays SR, Golden JA, Kukreja J, Greenland JR, Calabrese DR. Frailty and genetic risk predict fracture after lung transplantation. Am J Transplant 2023; 23:214-222. [PMID: 36695698 PMCID: PMC10037703 DOI: 10.1016/j.ajt.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 01/07/2023]
Abstract
Fractures negatively impact quality of life and survival. We hypothesized that recipient frailty score and genetic profile measured before transplant would predict risk of fracture after lung transplant. We conducted a retrospective cohort study of bone mineral density (BMD) and fracture among lung transplant recipients at a single center. The association between predictors and outcomes were assessed by multivariable time-dependent Cox models or regression analysis. Among the 284 participants, osteoporosis and fracture were highly prevalent. Approximately 59% of participants had posttransplant osteopenia, and 35% of participants developed at least 1 fracture. Low BMD was associated with a polygenic osteoporosis risk score, and the interaction between genetic score and BMD predicted fracture. Pretransplant frailty was associated with risk for spine and hip fracture, which were not associated with chronic lung allograft dysfunction or death. Chest fractures were the most frequent type of fracture and conferred a 2.2-fold increased risk of chronic lung allograft dysfunction or death (time-dependent P < .001). Pneumonia, pleural effusions, and acute rejection frequently occurred surrounding chest fracture. Pretransplant frailty and recipient genotype may aid clinical risk stratification for fracture after transplant. Fracture carries significant morbidity, underscoring the importance of surveillance and osteoporosis prevention.
Collapse
Affiliation(s)
- Trisha A Macrae
- Department of Medicine, University of California, San Francisco, California, USA
| | - Jose Lazo
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Judy Viduya
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Rebecca Florez
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Katherine Dewey
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Ying Gao
- Department of Medicine, University of California, San Francisco, California, USA
| | - Jonathan P Singer
- Department of Medicine, University of California, San Francisco, California, USA
| | - Steven R Hays
- Department of Medicine, University of California, San Francisco, California, USA
| | - Jeffrey A Golden
- Department of Medicine, University of California, San Francisco, California, USA
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, California, USA
| | - John R Greenland
- Department of Medicine, University of California, San Francisco, California, USA; Medical Service, Veterans Affairs Health Care System, San Francisco, California, USA
| | - Daniel R Calabrese
- Department of Medicine, University of California, San Francisco, California, USA; Medical Service, Veterans Affairs Health Care System, San Francisco, California, USA.
| |
Collapse
|
9
|
Park MS. Medical Complications of Lung Transplantation. J Chest Surg 2022; 55:338-356. [PMID: 35924543 PMCID: PMC9358167 DOI: 10.5090/jcs.22.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Kanade R, Kler A, Banga A. Non-pulmonary complications after lung transplantation: part II. Indian J Thorac Cardiovasc Surg 2021; 38:290-299. [DOI: 10.1007/s12055-021-01231-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022] Open
|
11
|
Impact of bone-active drugs and underlying disease on bone health after lung transplantation: A longitudinal study. J Cyst Fibros 2021; 20:e100-e107. [PMID: 34366281 DOI: 10.1016/j.jcf.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/15/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION the effect of bone-active drugs on the risk of fragility fractures (Fx), bone mineral density (BMD) and trabecular bone score (TBS) changes in patients receiving lung transplantation (LTx) is largely unknown. This study assessed the bone-active drugs effect in patients undergoing LTx both with (CF) and without (nCF) cystic-fibrosis. METHODS We evaluated incident Fx, both clinical and morphometric vertebral Fx by spinal X-ray, BMD and trabecular bone score (TBS) in 117 patients (CF=50, nCF n = 67) before and 24-months after LTx. A bone-active therapy was proposed to all LTx candidates. RESULTS 83.8% of patients started a bone-active drug. Lumbar-spine (LS) T-score improved significantly only in treated patients (-1.4 ± 1.0 vs -2.0±1.0, p = 0.0001), whereas femur BMD and TBS remained stable in treated and not treated subjects. The rate of incident Fx was 15.3%, with no difference between treated and not treated patients. After LTx, LS T-score improved significantly only in nCF group (-1.3 ± 1.0 vs -1.8 ± 1.1, p = 0.0001), while femur remained stable in both nCF and CF groups. Patients with CF showed a significant Z-TBS increase (-3.6 ± 1.7 vs -3.0 ± 1.7, p = 0.019) and a lower Fx incidence as compared with nCF patients (4.1% vs 24.2%, p =0.003). Incident Fx were associated with nCF diagnosis (OR 7.300, CI95% 1.385-38.461, p = 0.019) regardless of prevalent Fx, previous glucocorticoid therapy and bone-active therapy introduced at least 6 months before LTx. CONCLUSIONS A prompt medical intervention helps in preventing BMD loss after LTx. As compared with nCF patients, CF patients show a TBS increase and a lower Fx risk after LTx.
Collapse
|
12
|
Caffarelli C, Tomai Pitinca MD, Alessandri M, Cameli P, Bargagli E, Bennett D, Fossi A, Bernazzali S, Gonnelli S. Timing of Osteoporotic Vertebral Fractures in Lung and Heart Transplantation: A Longitudinal Study. J Clin Med 2020; 9:jcm9092941. [PMID: 32933025 PMCID: PMC7565939 DOI: 10.3390/jcm9092941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
Bone loss and bone fractures are common complications after organ transplantation. Many factors contribute to the pathogenesis of transplant osteoporosis, such as bone disease preceding transplantation, immunosuppressive medications, and nutritional and lifestyle factors. This study aimed to assess the incidence of vertebral fractures before and after lung and heart transplantation. This longitudinal study analyzed 213 electronic medical records of patients who underwent lung transplantation (n = 128) and heart transplantation (n = 85) at Siena University Medical Center between January 2000 and December 2018. In lung and heart transplant recipients, the bone mineral density in the femoral sub-regions show a significant decrease at post-transplantation and at follow up visits. In both lung and heart recipients, we found an increase in the fracture incidence in the first period after transplantation (19.5% vs. 50.4% in lung recipients; 9.6% vs. 25.7% in heart recipients). Moreover, in lung recipients, vertebral fractures were predicted primarily by age, BMD at the femur, and any history of fracture. In heart recipients, vertebral fractures were predicted only by history of fracture. Our study supports the recommendations for pre-transplant osteoporosis screening in patients undergoing lung transplants, and in the first period after transplantation in heart transplant recipients.
Collapse
Affiliation(s)
- Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (M.D.T.P.); (M.A.); (S.G.)
- Correspondence: ; Tel.: +39-0577-585468; Fax: +39-0577-233446
| | - Maria D. Tomai Pitinca
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (M.D.T.P.); (M.A.); (S.G.)
| | - Mario Alessandri
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (M.D.T.P.); (M.A.); (S.G.)
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (P.C.); (E.B.); (D.B.); (A.F.)
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (P.C.); (E.B.); (D.B.); (A.F.)
| | - David Bennett
- Respiratory Diseases and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (P.C.); (E.B.); (D.B.); (A.F.)
| | - Antonella Fossi
- Respiratory Diseases and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (P.C.); (E.B.); (D.B.); (A.F.)
| | - Sonia Bernazzali
- Department of Cardiac Surgery, University of Siena, 53100 Siena, Italy;
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (M.D.T.P.); (M.A.); (S.G.)
| |
Collapse
|
13
|
Gupta A, Jayes LR, Holmes S, Sahota O, Canavan M, Elkin SL, Lim K, Murphy AC, Singh S, Towlson EA, Ward H, Scullion J, McKeever TM, Bolton CE. Management of Fracture Risk in Patients with Chronic Obstructive Pulmonary Disease (COPD): Building a UK Consensus Through Healthcare Professional and Patient Engagement. Int J Chron Obstruct Pulmon Dis 2020; 15:1377-1390. [PMID: 32606647 PMCID: PMC7311204 DOI: 10.2147/copd.s233398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/23/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Osteoporosis and bone fractures are common in chronic obstructive pulmonary disease (COPD) and contribute significantly to morbidity and mortality. Current national guidance on COPD management recommends addressing bone health in patients, however, does not detail how. This consensus outlines key elements of a structured approach to managing bone health and fracture risk in patients with COPD. Methods A systematic approach incorporating multifaceted methodologies included detailed patient and healthcare professional (HCP) surveys followed by a roundtable meeting to reach a consensus on what a pathway would look like. Results The surveys revealed that fracture risk was not always assessed despite being recognised as an important aspect of COPD management by HCPs. The majority of the patients also stated they would be receptive to discussing treatment options if found to be at risk of osteoporotic fractures. Limited time and resource allocation were identified as barriers to addressing bone health during consultations. The consensus from the roundtable meeting was that a proactive systematic approach to assessing bone health should be adopted. This should involve using fracture risk assessment tools to identify individuals at risk, investigating secondary causes of osteoporosis if a diagnosis is made and reinforcing non-pharmacological and preventative measures such as smoking cessation, keeping active and pharmacological management of osteoporosis and medicines management of corticosteroid use. Practically, prioritising patients with important additional risk factors, such as previous fragility fractures, older age and long-term oral corticosteroid use for an assessment, was felt required. Conclusion There is a need for integrating fracture risk assessment into the COPD pathway. Developing a systematic and holistic approach to addressing bone health is key to achieving this. In tandem, opportunities to disseminate the information and educational resources are also required.
Collapse
Affiliation(s)
- Ayushman Gupta
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Leah R Jayes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Steve Holmes
- General Practitioner, Park Medical Partnership, Shepton Mallet, UK
| | - Opinder Sahota
- Department of Geriatric Medicine, Nottingham University Hospitals Trust, Nottingham, UK
| | - Melissa Canavan
- Department of Respiratory, Respiratory Care Solutions, Leeds, UK
| | - Sarah L Elkin
- Department of Respiratory Medicine, Imperial College Healthcare Trust, London W2 1NY, UK; Airways Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Kelvin Lim
- Eastwood Primary Care Centre, Eastwood, Nottingham, UK
| | - Anna C Murphy
- Department of Pharmacy, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally Singh
- Department of Respiratory Science, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Respiratory Science, University of Leicester, Leicester, UK
| | | | - Helen Ward
- Faculty of Medicine, The Royal Wolverhampton NHS Trust, West Midlands, UK
| | - Jane Scullion
- Department of Respiratory Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Charlotte E Bolton
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| |
Collapse
|
14
|
Rheumatologic Manifestations of CF. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
15
|
Anastasilakis AD, Tsourdi E, Makras P, Polyzos SA, Meier C, McCloskey EV, Pepe J, Zillikens MC. Bone disease following solid organ transplantation: A narrative review and recommendations for management from The European Calcified Tissue Society. Bone 2019; 127:401-418. [PMID: 31299385 DOI: 10.1016/j.bone.2019.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Solid organ transplantation is an established therapy for end-stage organ failure. Both pre-transplantation bone disease and immunosuppressive regimens result in rapid bone loss and increased fracture rates. METHODS The European Calcified Tissue Society (ECTS) formed a working group to perform a systematic review of existing literature on the consequences of end-stage kidney, liver, heart, and lung disease on bone health. Moreover, we assessed the characteristics of post-transplant bone disease and the skeletal effects of immunosuppressive agents and aimed to provide recommendations for the prevention and treatment of transplantation-related osteoporosis. RESULTS Characteristics of bone disease may differ depending on the organ that fails, but patients awaiting solid organ transplantation frequently depict a wide spectrum of bone and mineral abnormalities. Common features are a decreased bone mass and impaired bone strength with consequent high fracture risk, all of which are aggravated in the early post-transplantation period. CONCLUSION Both the underlying disease leading to end-stage organ failure and the immunosuppression regimens implemented after successful organ transplantation have detrimental effects on bone mass, quality and strength. Given existing ample data confirming the high frequency of bone disease in patients awaiting solid organ transplantation, we recommend that all transplant candidates should be assessed for osteoporosis and fracture risk and, if indicated, treated before and after transplantation. Since bone loss in the early post-transplantation period occurs in virtually all solid organ recipients and is associated with glucocorticoid administration, the goal should be to use the lowest possible dose and to taper and withdraw glucocorticoids as early as possible.
Collapse
Affiliation(s)
| | - Elena Tsourdi
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Force & VA General Hospital, Athens, Greece
| | - Stergios A Polyzos
- First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christian Meier
- Division of Endocrinology, Diabetology and Metabolism, University Hospital and University of Basel, Switzerland
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Rome, Italy
| | - M Carola Zillikens
- Bone Center, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
| |
Collapse
|
16
|
Sidhaye A, Goldswieg B, Kaminski B, Blackman SM, Kelly A. Endocrine complications after solid-organ transplant in cystic fibrosis. J Cyst Fibros 2019; 18 Suppl 2:S111-S119. [DOI: 10.1016/j.jcf.2019.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 01/07/2023]
|
17
|
Mainbourg S, Durieu I, Dehillotte C, Reynaud Q. Extra-respiratory comorbidities and transplantation in the French cystic fibrosis registry. Expert Rev Respir Med 2019; 13:799-802. [DOI: 10.1080/17476348.2019.1638768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Sabine Mainbourg
- Department of Internal Medicine Adult Cystic Fibrosis Care Center, Hospices Civils de Lyon, Lyon, France
- EA HESPER 7425, Université Claude Bernard Lyon 1, Lyon, France
| | - Isabelle Durieu
- Department of Internal Medicine Adult Cystic Fibrosis Care Center, Hospices Civils de Lyon, Lyon, France
- EA HESPER 7425, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Quitterie Reynaud
- Department of Internal Medicine Adult Cystic Fibrosis Care Center, Hospices Civils de Lyon, Lyon, France
- EA HESPER 7425, Université Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
18
|
Cairoli E, Eller-Vainicher C, Morlacchi LC, Tarsia P, Rossetti V, Pappalettera M, Arosio M, Chiodini I, Blasi F. Bone involvement in young adults with cystic fibrosis awaiting lung transplantation for end-stage respiratory failure. Osteoporos Int 2019; 30:1255-1263. [PMID: 30798331 DOI: 10.1007/s00198-019-04893-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
UNLABELLED Patients with cystic fibrosis awaiting lung transplantation for end-stage respiratory failure have high prevalence of reduced bone mineral density and fragility fracture. Suboptimal 25-hydroxyvitamin D levels could significantly contribute to the development of cystic fibrosis-related bone disease. INTRODUCTION The assessment of the prevalence of cystic fibrosis-related bone disease (CFBD) and its associated risk factors in young adults with cystic fibrosis (CF) awaiting lung transplantation for end-stage respiratory failure. METHODS Clinical characteristics, bone mineral density (BMD), the parameters of calcium metabolism, including vitamin D (25OHVitD) levels, and the presence of fragility fractures were evaluated in 42 CF patients (24 females, age 34.0 ± 8.4 years) consecutively referred as lung transplant candidates. RESULTS Mean 25OHVitD levels (54.9 ± 26.2 nmol/L) were below the reference range and hypovitaminosis D (25OHVitD < 75 nmol/L) was found in 34 patients (81%) and daily calcium intakes (median 550 mg/day) were lower than recommended. A BMD below the expected range for age (Z-score of - 2.0 or lower) and at least one prevalent fragility fracture were found in 22 patients (52.4%) and 18 patients (45.2%), respectively. The coexistence of low BMD and the presence of fracture was observed in 13 patients (31.0%). In these patients, the prevalence of nephrolithiasis was higher than in the remaining ones (p = 0.046). The presence of kidney stones was associated with a worse bone status and with severe vitamin D deficiency. In the whole sample, femoral BMD Z-scores were directly correlated with albumin-adjusted calcium (p < 0.05) and 25OHVitD levels (p < 0.01). CONCLUSIONS Despite the improvement of CF care, CFBD is still highly prevalent in young adults awaiting lung transplantation for end-stage CF. Suboptimal 25OHVitD levels could significantly contribute to the development of CFBD. The presence of nephrolithiasis could be an additional warning about the need for a careful evaluation of bone health in CF patients.
Collapse
Affiliation(s)
- E Cairoli
- Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - C Eller-Vainicher
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L C Morlacchi
- Respiratory Unit & Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Tarsia
- Respiratory Unit & Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Rossetti
- Respiratory Unit & Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Pappalettera
- Respiratory Unit & Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Arosio
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - I Chiodini
- Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - F Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Respiratory Unit & Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
19
|
Akyea RK, McKeever TM, Gibson J, Scullion JE, Bolton CE. Predicting fracture risk in patients with chronic obstructive pulmonary disease: a UK-based population-based cohort study. BMJ Open 2019; 9:e024951. [PMID: 30948576 PMCID: PMC6500346 DOI: 10.1136/bmjopen-2018-024951] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/23/2019] [Accepted: 02/20/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the incidence of hip fracture and all major osteoporotic fractures (MOF) in patients with chronic obstructive pulmonary disease (COPD) compared with non-COPD patients and to evaluate the use and performance of fracture risk prediction tools in patients with COPD. To assess the prevalence and incidence of osteoporosis. DESIGN Population-based cohort study. SETTING UK General Practice health records from The Health Improvement Network database. PARTICIPANTS Patients with an incident COPD diagnosis from 2004 to 2015 and non-COPD patients matched by age, sex and general practice were studied. OUTCOMES Incidence of fracture (hip alone and all MOF); accuracy of fracture risk prediction tools in COPD; and prevalence and incidence of coded osteoporosis. METHODS Cox proportional hazards models were used to assess the incidence rates of osteoporosis, hip fracture and MOF (hip, proximal humerus, forearm and clinical vertebral fractures). The discriminatory accuracies (area under the receiver operating characteristic [ROC] curve) of fracture risk prediction tools (FRAX and QFracture) in COPD were assessed. RESULTS Patients with COPD (n=80 874) were at an increased risk of fracture (both hip alone and all MOF) compared with non-COPD patients (n=308 999), but this was largely mediated through oral corticosteroid use, body mass index and smoking. Retrospectively calculated ROC values for MOF in COPD were as follows: FRAX: 71.4% (95% CI 70.6% to 72.2%), QFracture: 61.4% (95% CI 60.5% to 62.3%) and for hip fracture alone, both 76.1% (95% CI 74.9% to 77.2%). Prevalence of coded osteoporosis was greater for patients (5.7%) compared with non-COPD patients (3.9%), p<0.001. The incidence of osteoporosis was increased in patients with COPD (n=73 084) compared with non-COPD patients (n=264 544) (adjusted hazard ratio, 1.13, 95% CI 1.05 to 1.22). CONCLUSION Patients with COPD are at an increased risk of fractures and osteoporosis. Despite this, there is no systematic assessment of fracture risk in clinical practice. Fracture risk tools identify those at high risk of fracture in patients with COPD.
Collapse
Affiliation(s)
- Ralph Kwame Akyea
- Nottingham Respiratory Research Unit, NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Nottingham Respiratory Research Unit, NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jack Gibson
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jane E Scullion
- Institute for Lung Health, University Hospitals of Leicester Glenfield Site, Leicester, UK
| | - Charlotte E Bolton
- Nottingham Respiratory Research Unit, NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
20
|
Putman MS, Simoneau T, Feldman HA, Haagensen A, Boyer D. Low bone density and fractures before and after pediatric lung transplantation. Bone 2018; 111:129-134. [PMID: 29596964 PMCID: PMC5931383 DOI: 10.1016/j.bone.2018.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/26/2018] [Accepted: 03/26/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Children undergoing lung transplant are at risk for low bone mineral density (BMD) and fractures. The effect of lung transplantation on bone health in pediatric patients is unknown. MATERIALS AND METHODS We performed a retrospective chart review of all patients ages 2-21 years who underwent lung transplantation at our hospital from January 2000 to January 2015. RESULTS 51 patients were studied. At the time of transplant evaluation, BMD Z-score was -2.2 ± 1.4, and 59% of patients had low BMD. BMD Z-score declined in the first year after treatment and returned to near-baseline by the third post-transplant year. Fractures occurred in 9 patients (18%) before and 15 patients (29%) after transplant. Bisphosphonate use was associated with improvement in BMD Z-score and lower mortality risk. CONCLUSIONS Pediatric patients had a high prevalence of low BMD at the time of lung transplant evaluation. BMD Z-scores declined in the year after transplant and returned to the pre-transplant level by the third post-transplant year while remaining below normal levels. Fractures were common at sites associated with significant morbidity. These findings support efforts to optimize bone health before and after pediatric lung transplantation, and future studies are needed to evaluate the role of bisphosphonates in these patients.
Collapse
Affiliation(s)
- Melissa S Putman
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States; Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States.
| | - Tregony Simoneau
- Department of Pulmonary Medicine, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Henry A Feldman
- Clinical Research Center, Boston Children's Hospital, Boston, MA, United States
| | - Alexandra Haagensen
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
| | - Debra Boyer
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, United States
| |
Collapse
|
21
|
Jardel S, Reynaud Q, Durieu I. Long-term extrapulmonary comorbidities after lung transplantation in cystic fibrosis: Update of specificities. Clin Transplant 2018; 32:e13269. [DOI: 10.1111/ctr.13269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Sabine Jardel
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center; Hospices Civils de Lyon; Lyon France
- EA HESPER 7425; Université Claude Bernard Lyon 1; Lyon France
| | - Quitterie Reynaud
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center; Hospices Civils de Lyon; Lyon France
- EA HESPER 7425; Université Claude Bernard Lyon 1; Lyon France
| | - Isabelle Durieu
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center; Hospices Civils de Lyon; Lyon France
- EA HESPER 7425; Université Claude Bernard Lyon 1; Lyon France
| |
Collapse
|
22
|
Mailhot G, Dion N, Farlay D, Rizzo S, Bureau NJ, Jomphe V, Sankhe S, Boivin G, Lands LC, Ferraro P, Ste-Marie LG. Impaired rib bone mass and quality in end-stage cystic fibrosis patients. Bone 2017; 98:9-17. [PMID: 28254466 DOI: 10.1016/j.bone.2017.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Advancements in research and clinical care have considerably extended the life expectancy of cystic fibrosis (CF) patients. However, with this extended survival come comorbidities. One of the leading co-morbidities is CF-related bone disease (CFBD), which progresses with disease severity and places patients at high risk for fractures, particularly of the ribs and vertebrae. Evidence that CF patients with vertebral fractures had higher bone mineral density (BMD) than the nonfracture group led us to postulate that bone quality is impaired in these patients. We therefore examined rib specimens resected at the time of lung transplant in CF patients to measure parameters of bone quantity and quality. METHODS In this exploratory study, we analysed 19 end-stage CF and 13 control rib specimens resected from otherwise healthy lung donors. BMD, bone microarchitecture, static parameters of bone formation and resorption and microcrack density of rib specimens were quantified by imaging, histomorphometric and histological methods. Variables reflecting the mineralization of ribs were assessed by digitized microradiography. The degree of bone mineralization (g/cm3) and the heterogeneity index of the mineralization (g/cm3) were calculated for trabecular and cortical bone. RESULTS Compared to controls, CF ribs exhibited lower areal and trabecular volumetric BMD, decreased trabecular thickness and osteoid parameters, and increased microcrack density, that was particularly pronounced in specimens from patients with CF-related diabetes. Static parameters of bone resorption were similar in both groups. Degree of mineralization of total bone, but not heterogeneity index, was increased in CF specimens. CONCLUSION The combination of reduced bone mass, altered microarchitecture, imbalanced bone remodeling (maintained bone resorption but decreased formation), increased microdamage and a small increase of the degree of mineralization, may lead to decreased bone strength, which, when coupled with chronic coughing and chest physical therapy, may provide an explanation for the increased incidence of rib fractures previously reported in this population.
Collapse
Affiliation(s)
- Geneviève Mailhot
- Research Centre, CHU Sainte-Justine, 3175 Cote Sainte-Catherine Rd, Montreal, Québec H3T 1C5, Canada; Department of Nutrition, Faculty of Medicine, Université de Montreal, 2405 Cote Sainte-Catherine Rd, Montreal, Québec H3T 1A8, Canada.
| | - Natalie Dion
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, 1058 St-Denis Street, Montreal, Québec H2X 3J4, Canada.
| | - Delphine Farlay
- INSERM, UMR 1033, Univ Lyon, Université Claude Bernard Lyon 1, F69008 Lyon, France.
| | - Sébastien Rizzo
- INSERM, UMR 1033, Univ Lyon, Université Claude Bernard Lyon 1, F69008 Lyon, France.
| | - Nathalie J Bureau
- Research Center, Centre Hospitalier de l'Université de Montréal, 1058 St-Denis Street, Montreal, Québec H2X 3J4, Canada; Department of Radiology, Faculty of Medicine, Université de Montreal, 2900, Boulevard Édouard-Montpetit, Montréal, Québec H3T 1J4, Canada.
| | - Valérie Jomphe
- Lung transplant Program, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke East Street, Montreal, Québec H2L 4M1, Canada.
| | - Safiétou Sankhe
- Research Centre, CHU Sainte-Justine, 3175 Cote Sainte-Catherine Rd, Montreal, Québec H3T 1C5, Canada.
| | - Georges Boivin
- INSERM, UMR 1033, Univ Lyon, Université Claude Bernard Lyon 1, F69008 Lyon, France.
| | - Larry C Lands
- Department of Pediatrics, Montreal Children's Hospital-McGill University Health Centre, Meakins Christie Laboratories, Research Institute of the McGill University Health Centre, 1001 Décarie Boulevard, Montreal, Québec H4A 3J1, Canada; Respiratory Medicine, Centre Hospitalier de l'Universite de Montreal, 1560 Sherbrooke East Street, Montreal, Québec H2L 4M1, Canada.
| | - Pasquale Ferraro
- Research Center, Centre Hospitalier de l'Université de Montréal, 1058 St-Denis Street, Montreal, Québec H2X 3J4, Canada; Lung transplant Program, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke East Street, Montreal, Québec H2L 4M1, Canada; Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, 1058 St-Denis Street, Montreal, Québec H2X 3J4, Canada.
| | - Louis-Georges Ste-Marie
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, 1058 St-Denis Street, Montreal, Québec H2X 3J4, Canada.
| |
Collapse
|
23
|
Rieder FJJ, Gröschel C, Kastner MT, Kosulin K, Laengle J, Zadnikar R, Marculescu R, Schneider M, Lion T, Bergmann M, Kallay E, Steininger C. Human cytomegalovirus infection downregulates vitamin-D receptor in mammalian cells. J Steroid Biochem Mol Biol 2017; 165:356-362. [PMID: 27520300 PMCID: PMC5705058 DOI: 10.1016/j.jsbmb.2016.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 12/31/2022]
Abstract
Vitamin D (VD) is essential for the human body and involved in a wide variety of critical physiological processes including bone, muscle, and cardiovascular health, as well as innate immunity and antimicrobial responses. Here, we elucidated the significance of the VD system in cytomegalovirus (CMV) infection, which is one of the most common opportunistic infections in immunocompromised or -suppressed patients. We found that expression of vitamin D receptor (VDR) was downregulated in CMV-infected cells within 12h [hrs] post infection [p.i.] to 12% relative to VDR expression in mock-infected fibroblasts and did not recover during the CMV replication cycle of 96h. None of the biologically active metabolites of VD, cholecalciferol, calcidiol, or calcitriol, inhibit CMV replication significantly in human fibroblasts. In a feedback loop, expression of CYP24A1 dropped to 3% by 12h p.i. and expression of CYP27B1 increased gradually during the replication cycle of CMV to 970% probably as a consequence of VDR inhibition. VDR expression was not downregulated during influenza virus or adenovirus replication. The potent synthetic vitamin D analog EB-1089 was not able to inhibit CMV replication or antagonize its effect on VDR expression. Only CMV replication, and none of the other viral pathogens evaluated, inhibited the vitamin D system in vitro. In view of the pleiotropism of VDR, CMV-mediated downregulation may have far-reaching virological, immunological, and clinical implications and thus warrant further evaluations in vitro and in vivo.
Collapse
Affiliation(s)
- Franz J J Rieder
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Charlotte Gröschel
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Marie-Theres Kastner
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Karin Kosulin
- Children's Cancer Research Institute, Vienna, Austria
| | - Johannes Laengle
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Rene Zadnikar
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Martina Schneider
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Lion
- Children's Cancer Research Institute, Vienna, Austria; Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Michael Bergmann
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Enikö Kallay
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Christoph Steininger
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
24
|
Caffarelli C, Gonnelli S, Tomai Pitinca MD, Francolini V, Fui A, Bargagli E, Refini RM, Bennett D, Nuti R, Rottoli P. Idiopathic pulmonary fibrosis a rare disease with severe bone fragility. Intern Emerg Med 2016; 11:1087-1094. [PMID: 27393142 DOI: 10.1007/s11739-016-1501-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a rare form of chronic, progressive fibrosing interstitial pneumonia of unknown cause. The aim of this cross-sectional study was to assess the prevalence of osteoporosis and fragility fracture in a population of adults with IPF and to identify whether any possible clinical and pulmonary function parameters may be associated with increased bone fragility. In 58 IPF patients (mean age 65.1 ± 9.1 years), we measured bone mineral density (BMD) of the lumbar spine, the femoral neck, and the entire hip. Moreover, the presence of vertebral fractures on a lateral chest X-ray study was evaluated, and a vertebral fracture burden was quantified using the spinal deformity index (SDI). As expected, osteoporosis was significantly more frequent in females with respect to males (57.9 vs 20.5 %, respectively), whereas the fractures prevailed in males with respect to females (38.5 vs 26.3 %, respectively). There were positive correlations between BMD at all skeletal sites and respiratory parameters; in particular for FVC % and DLCO % with BMD at femoral sub-regions. Moreover, we compared the average of DLCO (%) measure by values of SDI score that was higher in those patients with lower values of DLCO (%). The study shows a high prevalence of fragility with vertebral fractures in IPF patients, especially in males. Moreover, the vertebral fracture burden is associated with a worsening of FVC (%) and DLCO (%). Therefore, an evaluation of bone status is recommended, especially in those patients who are candidates for lung transplantation.
Collapse
Affiliation(s)
- Carla Caffarelli
- UOC Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
| | - Stefano Gonnelli
- UOC Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Maria Dea Tomai Pitinca
- UOC Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Valentina Francolini
- UOC Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Annalisa Fui
- UOC Respiratory Diseases and Lung Transplantation, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Elena Bargagli
- UOC Respiratory Diseases and Lung Transplantation, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Rosa Metella Refini
- UOC Respiratory Diseases and Lung Transplantation, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - David Bennett
- UOC Respiratory Diseases and Lung Transplantation, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Ranuccio Nuti
- UOC Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Paola Rottoli
- UOC Respiratory Diseases and Lung Transplantation, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| |
Collapse
|
25
|
Xie Z, He Y, Sun Y, Lin Z, Yang M, Liu Q, Liu S. Association between pulmonary fibrosis and osteoporosis in the elderly people: A case-control study. Medicine (Baltimore) 2016; 95:e5239. [PMID: 27858878 PMCID: PMC5591126 DOI: 10.1097/md.0000000000005239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 12/19/2022] Open
Abstract
In this case-control study, we evaluated the association between osteoporosis and pulmonary fibrosis in the elderly. Participants were divided into a test group and a control group depending on bone mineral density and grid pattern changes of pulmonary fibrosis. We measured general conditions, related risk factors, serum biochemical index, grid pattern changes of double lungs, pulmonary function, arterial oxygen pressure (PO2), and bone mineral density of participates, and investigated the data through statistical analysis on SPSS 17.0 (SPSS Inc, Chicago, Illinois, USA). Significant differences were observed between groups in all collected indices except PO4. The ratio of pulmonary function disorder was higher in the test group versus the control group (12.0% vs 4.3%). Logistic regression shows that pulmonary fibrosis is a risk factor of osteoporosis, independent of age, sex, body mass index, smoking status, diabetes mellitus, alkaline phosphatase, glycosylated hemoglobin, Ca, PO4, tumor necrosis factor-α, vitamin D total, ventilation disorder, diffusive dysfunction, and hypoxemia. Senile osteoporosis is closely associated with pulmonary fibrosis, diabetes mellitus, smoking, sexuality, age, and body mass index. Pulmonary fibrosis modestly affects the incidence of osteoporosis and thus is a more promising predictor of osteoporosis.
Collapse
Affiliation(s)
- Zhong Xie
- Department of Spine Surgery, the First Affiliated Hospital of University of South China, Heangyang, Hunan Province
| | - Yanhong He
- Center of bone trauma diagnostic and treatment, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan Province
| | - Yongqiang Sun
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zhanzhan Lin
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Mingzhi Yang
- Department of Spine Surgery, the First Affiliated Hospital of University of South China, Heangyang, Hunan Province
| | - Qian Liu
- Department of Spine Surgery, the First Affiliated Hospital of University of South China, Heangyang, Hunan Province
| | - Sihai Liu
- Department of Spine Surgery, the First Affiliated Hospital of University of South China, Heangyang, Hunan Province
| |
Collapse
|
26
|
Rittweger J, Debevec T, Frings-Meuthen P, Lau P, Mittag U, Ganse B, Ferstl PG, Simpson EJ, Macdonald IA, Eiken O, Mekjavic IB. On the combined effects of normobaric hypoxia and bed rest upon bone and mineral metabolism: Results from the PlanHab study. Bone 2016; 91:130-8. [PMID: 27443510 DOI: 10.1016/j.bone.2016.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/29/2016] [Accepted: 07/17/2016] [Indexed: 01/10/2023]
Abstract
Bone losses are common as a consequence of unloading and also in patients with chronic obstructive pulmonary disease (COPD). Although hypoxia has been implicated as an important factor to drive bone loss, its interaction with unloading remains unresolved. The objective therefore was to assess whether human bone loss caused by unloading could be aggravated by chronic hypoxia. In a cross-over designed study, 14 healthy young men underwent 21-day interventions of bed rest in normoxia (NBR), bed rest in hypoxia (HBR), and hypoxic ambulatory confinement (HAmb). Hypoxic conditions were equivalent to 4000m altitude. Bone metabolism (NTX, P1NP, sclerostin, DKK1) and phospho-calcic homeostasis (calcium and phosphate serum levels and urinary excretion, PTH) were assessed from regular blood samples and 24-hour urine collections, and tibia and femur bone mineral content was assessed by peripheral quantitative computed tomography (pQCT). Urinary NTX excretion increased (P<0.001) to a similar extent in NBR and HBR (P=0.69) and P1NP serum levels decreased (P=0.0035) with likewise no difference between NBR and HBR (P=0.88). Serum total calcium was increased during bed rest by 0.059 (day D05, SE 0.05mM) to 0.091mM (day D21, P<0.001), with no additional effect by hypoxia during bed rest (P=0.199). HAmb led, at least temporally, to increased total serum calcium, to reduced serum phosphate, and to reduced phosphate and calcium excretion. In conclusion, hypoxia did not aggravate bed rest-induced bone resorption, but led to changes in phospho-calcic homeostasis likely caused by hyperventilation. Whether hyperventilation could have mitigated the effects of hypoxia in this study remains to be established.
Collapse
Affiliation(s)
- Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany; Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany.
| | - Tadej Debevec
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
| | - Patrick Lau
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
| | - Uwe Mittag
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
| | - Bergita Ganse
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
| | - Philip G Ferstl
- Medizinische Klinik I, University of Frankfurt, Frankfurt, Germany
| | - Elizabeth J Simpson
- MRC/Arthritis UK Centre for Musculoskeletal Aging Research, University of Nottingham Medical School, School of Life Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Ian A Macdonald
- MRC/Arthritis UK Centre for Musculoskeletal Aging Research, University of Nottingham Medical School, School of Life Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Ola Eiken
- Department of Environmental Physiology, Swedish Aerospace Physiology Centre, Royal Institute of Technology, Stockholm, Sweden
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
27
|
Lee IS, Leem AY, Lee SH, Rhee Y, Ha Y, Kim YS. Relationship between pulmonary function and bone mineral density in the Korean National Health and Nutrition Examination Survey. Korean J Intern Med 2016; 31:899-909. [PMID: 27604798 PMCID: PMC5016283 DOI: 10.3904/kjim.2015.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/20/2014] [Accepted: 01/06/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Osteoporosis is common in chronic obstructive pulmonary disease (COPD) patients. The relationship between osteoporosis and COPD has been primarily reported in patients with moderate to severe COPD, but there is no report in the general population. The aim of this study is to investigate the relationship between bone mineral density (BMD) and lung function in the general Korean population. METHODS This study was based on data acquired from the Fourth and Fifth Korea National Health and Nutrition Examination Surveys (KNHANES IV and V), conducted from 2008 to 2010. The study population included 4,501 subjects (aged ≥ 50 years) who underwent both spirometry and BMD. The study populations were divided into two groups by sex to correct for the effects of gender on BMD. All female participants were postmenopausal women. RESULTS The BMD values of the femur neck, total femur, and L-spine tended to decrease with degree of airflow limitation in both genders. To correct confounding factors, data were analyzed and adjusted for age, body mass index, fat free mass index, body fat percentage, smoking amount, parathyroid hormone levels, daily calcium and phosphorus intake, and alkaline phosphatase (ALP) levels. While the BMD of the femur neck, total femur, and L-spine was reduced significantly as age and ALP increased, the correlation between airway obstruction and BMD of all regions disappeared in both genders. CONCLUSIONS In the general population aged 50 years and older, diminution of BMD is not associated with airway obstruction. Further investigation along other factors is needed to determine the possible role of pulmonary function and BMD.
Collapse
Affiliation(s)
- In Seon Lee
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Leem
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Lee
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Young Sam Kim, M.D. Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1971 Fax: +82-2-393-6884 E-mail:
| |
Collapse
|
28
|
Budev MM, Yun JJ. Medical complications after lung transplantation. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
29
|
Sarkar M, Bhardwaj R, Madabhavi I, Khatana J. Osteoporosis in chronic obstructive pulmonary disease. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:5-21. [PMID: 25788838 PMCID: PMC4358421 DOI: 10.4137/ccrpm.s22803] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/28/2015] [Accepted: 02/11/2015] [Indexed: 12/21/2022]
Abstract
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.
Collapse
Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajeev Bhardwaj
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Irappa Madabhavi
- Department of Medical and Pediatric Oncology, GCRI, Ahmedabad, Gujarat, India
| | - Jasmin Khatana
- Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| |
Collapse
|
30
|
Abstract
Ageing is associated with a progressive degeneration of the tissues, which has a negative impact on the structure and function of vital organs and is among the most important known risk factors for most chronic diseases. Since the proportion of the world's population aged >60 years will double in the next four decades, this will be accompanied by an increased incidence of chronic age-related diseases that will place a huge burden on healthcare resources. There is increasing evidence that many chronic inflammatory diseases represent an acceleration of the ageing process. Chronic pulmonary diseases represents an important component of the increasingly prevalent multiple chronic debilitating diseases, which are a major cause of morbidity and mortality, particularly in the elderly. The lungs age and it has been suggested that chronic obstructive pulmonary disease (COPD) is a condition of accelerated lung ageing and that ageing may provide a mechanistic link between COPD and many of its extrapulmonary effects and comorbidities. In this article we will describe the physiological changes and mechanisms of ageing, with particular focus on the pulmonary effects of ageing and how these may be relevant to the development of COPD and its major extrapulmonary manifestations.
Collapse
Affiliation(s)
- William MacNee
- ELEGI Colt Research Laboratories, MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Roberto A Rabinovich
- ELEGI Colt Research Laboratories, MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Gourab Choudhury
- ELEGI Colt Research Laboratories, MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
31
|
Enhanced F508del-CFTR Channel Activity Ameliorates Bone Pathology in Murine Cystic Fibrosis. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:1132-1141. [DOI: 10.1016/j.ajpath.2013.12.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/25/2013] [Accepted: 12/02/2013] [Indexed: 11/23/2022]
|
32
|
Picard C, Boisseau M, De Miranda S, Hamid A, Grenet D, Parquin F, Sage E, Stern M, Roux A. [The management of lung transplantation candidates. A case series]. Rev Mal Respir 2014; 32:1-7. [PMID: 25618198 DOI: 10.1016/j.rmr.2014.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 12/09/2013] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Lung transplantation (LT) is associated with an increased risk of infection, cancer, chronic renal failure, cardiovascular disease and osteoporosis. Some risk factors precede transplantation and could benefit for early diagnosis and optimised care. METHODS The incidence of comorbidities and their treatment before referral were assessed in 157 consecutive lung transplant candidates between 2008 and 2011. RESULTS The median age was 37years [25; 51]. Fifty-six percent had a body mass index below 19kg/m(2). In the COPD group, only 50 % had undergone a pulmonary rehabilitation program in the preceding 2 years. Osteoporosis was present in 42 %, of whom 36 % were on bisphophonate therapy. Vitamin D deficiency was present in 65 %. Previously undiagnosed cardiovascular risk factors were discovered during LT assessment: hypertension in one patient, hypercholesterolemia in 6 % and diabetes in 4 %. Poor dental condition necessitating extractions were found in 41 % of patients. Protective anti-HBs antibodies levels were present in 50 % of the patients at the time of referral. CONCLUSION The assessment and early treatment of nutritional disorders, osteoporosis and risk factors for infection as well as addressing associated cardiovascular risk factors should be optimised in the care of patients with chronic respiratory insufficiency. The potential for becoming a lung transplant candidate in the future should be kept in mind early in the global management of those patients.
Collapse
Affiliation(s)
- C Picard
- Service de pneumologie, hôpital Foch, groupe de transplantation pulmonaire, 40, rue Worth, 92150 Suresnes, France.
| | - M Boisseau
- Service de pneumologie, hôpital Foch, groupe de transplantation pulmonaire, 40, rue Worth, 92150 Suresnes, France
| | - S De Miranda
- Service de pneumologie, hôpital Foch, groupe de transplantation pulmonaire, 40, rue Worth, 92150 Suresnes, France
| | - A Hamid
- Service de pneumologie, hôpital Foch, groupe de transplantation pulmonaire, 40, rue Worth, 92150 Suresnes, France
| | - D Grenet
- Service de pneumologie, hôpital Foch, groupe de transplantation pulmonaire, 40, rue Worth, 92150 Suresnes, France
| | - F Parquin
- Unité de soins intensifs respiratoires, service de chirurgie thoracique, hôpital Foch, groupe de transplantation pulmonaire, 92150 Suresnes, France
| | - E Sage
- Unité de soins intensifs respiratoires, service de chirurgie thoracique, hôpital Foch, groupe de transplantation pulmonaire, 92150 Suresnes, France
| | - M Stern
- Service de pneumologie, hôpital Foch, groupe de transplantation pulmonaire, 40, rue Worth, 92150 Suresnes, France
| | - A Roux
- Service de pneumologie, hôpital Foch, groupe de transplantation pulmonaire, 40, rue Worth, 92150 Suresnes, France
| |
Collapse
|
33
|
Incidence of fractures after cardiac and lung transplantation: a single center experience. J Osteoporos 2014; 2014:573041. [PMID: 24864223 PMCID: PMC4016909 DOI: 10.1155/2014/573041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 11/24/2022] Open
Abstract
Osteoporotic fractures are well-known complications of organ transplantation. Fracture rates up to 35% have been previously reported following heart and lung transplantations. Our institutional pretransplant protocols include DXA scans, vitamin D screening, and appropriate antiresorptive therapy. We aimed to assess the incidence of fragility fractures following cardiac or lung transplantation. In a retrospective study 210 electronic medical records of patients who underwent LT (110 men, 100 women) and 105 HT (88 men, 17 women) between 2005 and 2010 were analyzed. Both clinical and radiographic fractures were recorded. DXA scans were obtained immediately after transplant. 17 out of 210 LT patients (8.0%) had fractures after transplantation and 9 out of 105 HT patients (8.6%) had fractures. The median time to the first fracture was 12 months and the mean time was 18 months for both LT and HT. In the HT recipients, the median femoral neck T score was statistically lower in the fracture group versus the nonfracture group. Similar results were seen in the LT patients. Conclusion. Our findings demonstrate a much lower incidence of fractures in heart and lung transplant recipients in comparison with earlier reports. Comprehensive bone care and early initiation of antiresorptive therapy are possible contributors to these improved outcomes.
Collapse
|
34
|
Calcidiol deficiency in end-stage organ failure and after solid organ transplantation: status quo. Nutrients 2013; 5:2352-71. [PMID: 23857217 PMCID: PMC3738977 DOI: 10.3390/nu5072352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 12/13/2022] Open
Abstract
Among patients with organ failure, vitamin D deficiency is extremely common and frequently does not resolve after transplantation. This review crystallizes and summarizes existing data on the status quo of vitamin D deficiency in patients with organ failure and in solid organ transplant recipients. Interventional studies evaluating different treatment strategies, as well as current clinical practice guidelines and recommendations on the management of low vitamin D status in these patients are also discussed.
Collapse
|
35
|
Chauhan V, Ranganna KM, Chauhan N, Vaid M, Kelepouris E. Bone disease in organ transplant patients: pathogenesis and management. Postgrad Med 2012; 124:80-90. [PMID: 22691902 DOI: 10.3810/pgm.2012.05.2551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Bone disease is common in recipients of kidney, heart, lung, liver, and bone marrow transplants, and causes debilitating complications, such as osteoporosis, osteonecrosis, bone pain, and fractures. The frequency of fractures ranges from 6% to 45% for kidney transplant recipients to 22% to 42% for heart, lung, and liver transplant recipients. Bone disease in transplant patients is the sum of complex mechanisms that involve both preexisting bone disease before transplant and post-transplant bone loss due to the effects of immunosuppressive medications. Evaluation of bone disease should preferably start before the transplant or in the early post-transplant period and include assessment of bone mineral density and other metabolic factors that influence bone health. This requires close coordination between the primary care physician and transplant team. Patients should be stratified based on their fracture risk. Prevention and treatment include risk factor reduction, antiresorptive medications, such as bisphosphonates and calcitonin, calcitriol, and/or gonadal hormone replacement. A steroid-avoidance protocol may be considered.
Collapse
Affiliation(s)
- Veeraish Chauhan
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USA.
| | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE Decreased bone mineral density has been found in the advanced stages of various lung diseases. Limited data are available about prevalence and risk factors for osteoporosis/osteopenia (OP) in pulmonary arterial hypertension (PAH). METHODS Patients with PAH (either idiopathic or secondary to scleroderma [SSC-PAH]) who underwent bone density testing for lung transplant evaluation were included. Results of bone density testing, demographic data, pulmonary function testing, hemodynamic measures, and 6-minute walk distance test (6MWD) were collected. RESULTS Thirty-two patients were identified (27 women/5 men, 24 idiopathic PAH/8 SSC-PAH) and OP was found in 22 (69%) patients. Patients with SSC-PAH had more significant indications of OP at all of the measured sites. The OP group had lower FEV1 (P = 0.01) and a significantly lower 6MWD (P = 0.04) as compared with patients with PAH with normal bone density. Hemodynamics indicated no statistically significant differences between the groups other than a lower mean pulmonary artery pressure (P = 0.01) in the OP group. Patients with a history of corticosteroid use and smoking, postmenopausal status, decreased functional capacity (as measured by poor New York Heart Association functional class and 6MWD), SSC-PAH, and need for oxygen during a 6MWD test had an increased risk of OP by univariate logistic regression. CONCLUSIONS Reduced bone density can be seen in a majority of patients with advanced PAH. Risk factors for reduced bone density include SSC-PAH, reduced 6MWD, need for oxygen during 6MWD testing, reduced FEV1, a history of smoking or corticosteroid use, and postmenopausal status.
Collapse
|
37
|
Li H, He JW, Fu BS, Wang K, Jiang N, Wang GY, Zhang J, Wang GS, Yang Y, Chen GH. Immunosuppressant-related hip pain after orthotopic liver transplant. EXP CLIN TRANSPLANT 2012; 11:32-8. [PMID: 22813534 DOI: 10.6002/ect.2012.0026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Immunosuppressant-related hip pain can greatly affect a patient's mobility and increase the number of total hip arthroplasties. We investigated risk factors and causes of hip pain after orthotopic liver transplant. MATERIALS AND METHODS The medical records of 175 adult orthotopic liver transplant patients, who were followed-up for more than 2 years, were retrospectively reviewed. Data collected from the records included primary disease, medications, biochemical results, Child-Turcotte-Pugh score, death, rejection, and complications related to liver transplant. RESULTS A total of 11 patients (6.3%) complained of hip pain, which was diagnosed as calcineurin-inhibitor-induced pain syndrome in 4 patients (2.3%), osteonecrosis of the femoral head in 3 patients (1.7%), and osteoporosis in 2 patients (1.1%). The incidence of calcineurin-inhibitor-induced pain syndrome was related to the dosage of tacrolimus (P > .05) but independent of methylprednisolone use. The occurrence of osteonecrosis of the femoral head was independent of the dosage and early withdrawal of methylprednisolone (P > .05). Patients with methylprednisolone withdrawal within 6 months had significantly longer survival than those using methylprednisolone for more than 6 months (50 ± 15 vs 41 ± 18 mo; P = .007). CONCLUSIONS Calcineurin-inhibitor-induced pain syndrome and osteonecrosis of the femoral head are main causes of hip pain in adult orthotopic liver transplant patients. Osteonecrosis of the femoral head was not common, but the incidence of hip pain owing to calcineurin-inhibitor-induced pain syndrome was relatively high in orthotopic liver transplant patients. Early withdrawal of methylprednisolone could benefit the patients' survival.
Collapse
Affiliation(s)
- Hua Li
- Department of Hepatic Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Ar’eva GT, Sovetkina NV, Ovsyannikova NA, Ar’ev AL. Comorbid and multimorbid conditions in geriatrics: A review. ADVANCES IN GERONTOLOGY 2012. [DOI: 10.1134/s2079057012030022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
39
|
Lowery EM, Bemiss B, Cascino T, Durazo-Arvizu RA, Forsythe SM, Alex C, Laghi F, Love RB, Camacho P. Low vitamin D levels are associated with increased rejection and infections after lung transplantation. J Heart Lung Transplant 2012; 31:700-7. [DOI: 10.1016/j.healun.2012.02.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/06/2012] [Accepted: 02/02/2012] [Indexed: 10/28/2022] Open
|
40
|
Abstract
Transplantation is an established therapy for end-stage diseases of kidney, lung, liver, and heart among others. Osteoporosis and fragility fractures are serious complications of organ transplantation, particularly in the first post-transplant year. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. This review addresses the mechanisms of bone loss that occurs both in the early and late post-transplant periods, including the contribution of the immunosuppressive agents as well as the specific features to bone loss after kidney, lung, liver, cardiac, and bone marrow transplantation. Prevention and treatment for osteoporosis in the transplant recipient are also discussed.
Collapse
Affiliation(s)
- Carolina A Moreira Kulak
- Division of Endocrinology & Metabolism of Hospital de Clínicas-SEMPR, Federal University of Parana, Av. Agostinho Leão Júnior 285, Alto da Glória, Curitiba, Paraná, Cep: 80030-013, Brazil.
| | | | | | | |
Collapse
|
41
|
Affiliation(s)
- Yenna Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Soo Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Vitamin d status in patients with chronic obstructive pulmonary disease who participate in pulmonary rehabilitation. J Cardiopulm Rehabil Prev 2011; 31:261-7. [PMID: 21623214 DOI: 10.1097/hcr.0b013e31821c13aa] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Vitamin D deficiency is common in patients with chronic obstructive pulmonary disease; however, no study has evaluated the influence of vitamin D status on effects of pulmonary rehabilitation (PR). METHODS We studied 311 patients, who participated in a 7-week outpatient PR. Vitamin D status was assessed at entry and examined for association with patient characteristics, dropout from PR, and effect on endurance shuttle walk time. RESULTS Vitamin D level 25 nM was seen in 61 (19.6%) of the patients. They were significantly younger, were more frequently on long-term oxygen therapy, had higher body mass index and fat-free mass index, had worse quality of life score, tended to have lower percent predicted value for forced expiratory volume in the first second of expiration, and more frequently were current smokers. They had a 3-time higher risk of dropout from the PR program (P = .003) compared with patients with normal vitamin D status and a poorer improvement in endurance shuttle walk time (P = .03). DISCUSSION In conclusion, vitamin D deficiency was significantly associated with higher dropout rates from PR, and there was a tendency toward a poorer improvement in endurance shuttle walk time.
Collapse
|
43
|
Chen X, Zhu G, Jin T, Qin B, Zhou W, Gu S. Cadmium is more toxic on volume bone mineral density than tissue bone mineral density. Biol Trace Elem Res 2011; 144:380-7. [PMID: 21656269 DOI: 10.1007/s12011-011-9106-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
Abstract
It has been showed that Cd induces low areal bone mineral density, but we do not know the effect of Cd on cubic bone density. This study was aimed to investigate the effects of Cd on volumetric bone mineral density (VBMD) and tissue bone mineral density (TBMD) in male rats. Twenty-four Sprague-Dawley male rats were randomly divided into four groups that were given cadmium chloride by subcutaneous injection at doses of 0, 0.1, 0.5, and 1.5 mg/kg body weight for 8 weeks, respectively. Then, microcomputed tomography scanning was performed on the proximal tibia, and region of interest was reconstructed using microview software. The VBMD, bone volume fraction of rats treated with 1.5 mg Cd/kg, were significantly decreased compared to control (p < 0.01). The trabecular numbers of rats exposed to Cd were all significantly decreased relative to control (p < 0.05). The trabecular separation of rats treated with 1.5 mg Cd/kg was obviously increased compared to control (p < 0.01). However, Cd had no obvious influence on TBMD. Cd induced low VBMD but not TBMD; Cd effect on bone may be related with trabecular bone loss but not with trabecular bone demineralization.
Collapse
Affiliation(s)
- Xiao Chen
- Institute of Radiation Medicine, Fudan University, 200032, Shanghai, China
| | | | | | | | | | | |
Collapse
|
44
|
De Schepper J, Roggen I, Van Biervliet S, Robberecht E, Gies I, De Waele K, De Wachter E, Malfroot A, De Baets F, Toye K, Goemaere S, Louis O. Comparative bone status assessment by dual energy X-ray absorptiometry, peripheral quantitative computed tomography and quantitative ultrasound in adolescents and young adults with cystic fibrosis. J Cyst Fibros 2011; 11:119-24. [PMID: 22119452 DOI: 10.1016/j.jcf.2011.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/12/2011] [Accepted: 10/21/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Quantitative ultrasound bone sonometry (QUS) might be a promising screening method for cystic fibrosis (CF)-related bone disease, given its absence of radiation exposure, portability of the equipment and low cost.The value of axial transmission forearm QUS in detecting osteopenia in CF was therefore studied. METHODS We investigated the application of QUS in the evaluation of bone status in a group of 64 adolescents (>12 years) and young adults (<40 years) with CF in a comparison with a dual X-ray absorptiometry (DXA) of the whole body and peripheral quantitative computed tomography (pQCT) of the radius at 4% and 66% sites. RESULTS Mean (SD) Z-scores of speed of sound (SOS), whole body bone mineral content (BMC), radial trabecular bone mineral density (BMD), and radial cortical BMD were respectively -0.31 (0.78), -0.09 (1.28), 0.10 (1.16) and -0.62 (2.88). The pQCT determined bone geometry values (cortical bone area and cortical thickness) were more depressed than the BMD data. QUS had a sensitivity and specificity of respectively 0% and 96% for diagnosing osteopenia (based on a whole body BMC Z-score<-2). CONCLUSIONS QUS cannot replace DXA, but can screen out patients with normal bone mass. Further and larger studies are needed to examine if QUS may reflect other aspects than bone mass, or if it is possible to improve its sensitivity by supplementing the SOS results with clinical risk factors.
Collapse
Affiliation(s)
- Jean De Schepper
- Department of Pediatric Endocrinology, UZ Brussel, Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Baris S, Ozen A, Ercan H, Karakoc-Aydiner E, Cagan H, Ozdemir C, Barlan M, Bahceciler NN, Barlan IB. Osteoporosis: an ignored complication of CVID. Pediatr Allergy Immunol 2011; 22:676-83. [PMID: 21645119 DOI: 10.1111/j.1399-3038.2011.01187.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple factors in common variable immunodeficiency (CVID) might interfere with optimal growth and maturation and potentially compromise bone health. METHODS We aimed to evaluate bone mineral density (BMD) of patients with CVID using dual energy X-ray absorptiometry (DEXA) and investigate risk factors associated with decreased bone density. RESULTS Twenty-two patients were included (M: 16, F: 6) with a mean age of 15.6 ± 9.0 yr. DEXA revealed osteopenia in 6/22 (27.3%) and osteoporosis in 9/22 (40.9%) at lumbar spine and osteopenia in 7/19 (37%) and osteoporosis in 3/19 (16%) at femoral neck sites. The age of subjects with osteoporosis was significantly higher than those without (21.6 ± 8.0 vs. 9.0 ± 5.7 yr; p < 0.0001). BMD z-scores were significantly lower in patients with bronchiectasis compared with those without (p = 0.03). Patients with osteoporosis at femoral neck site had lower forced expiratory volume in 1 s (FEV(1) ) (p = 0.024), FEV(1) /forced vital capacity (FVC) (p < 0.0001), PEF (p = 0.008), and FEF 25-75 (p = 0.013) values compared with the patients with normal BMD z-scores. Low serum 25(OH) vitamin D levels were detected in 13/22 patients and low dietary calcium intake in 17/22 patients. BMD z-scores at femoral neck were lower in patients with low B-cell percentage (p = 0.03). BMD z-score at lumbar spine was correlated with folate (r = +0.63, p = 0.004) and serum immunoglobulin G levels (r = +0.430, p = 0.04). CONCLUSION Osteoporosis appeared as an emerging health problem of patients with CVID, the risk increasing with older age and poorer lung function. Nutritional, biochemical, and immunologic factors appeared to take part in decreased BMD. Insight into the mechanisms of osteoporosis in CVID is crucial to develop preventive strategies.
Collapse
Affiliation(s)
- Safa Baris
- Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
|
47
|
Tejero García S, Giráldez Sánchez MA, Cejudo P, Quintana Gallego E, Dapena J, García Jiménez R, Cano Luis P, Gómez de Terreros I. Bone Health, Daily Physical Activity, and Exercise Tolerance in Patients With Cystic Fibrosis. Chest 2011; 140:475-481. [DOI: 10.1378/chest.10-1508] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
48
|
Abstract
Vitamin D deficiency is prevalent among patients with end-stage organ failure awaiting transplant. Low serum 25-hydroxyvitamin D (25-OHD) levels in these patients may be related to many disease-specific factors, as well as decreased sunlight exposure and limited intake of foods containing vitamin D. Low serum 25-OHD levels are also extremely common following solid organ transplantation, both during the immediate postoperative period and in long-term graft recipients. Demographic and lifestyle factors are important in determining D status in transplant recipients. Worse vitamin D status is associated with poorer general health, lower albumin, and even decreased survival among these patients. Although several studies have demonstrated that active forms of vitamin D and its analogues prevent bone loss following transplantation, the data do not show consistent benefit. These therapies may have particular utility after renal transplantation. However, given the narrow therapeutic window with respect to hypercalcemia and hypercalciuria, and the demonstrated efficacy of bisphosphonates to prevent post-transplantation bone loss, we regard these agents as adjunctive rather than primary therapy for transplantation osteoporosis. The effects of 1,25(OH)(2)D on the immune system, which are still being elucidated, may have potential for reducing infections and preventing allograft rejection after transplantation.
Collapse
Affiliation(s)
- E M Stein
- Department of Medicine, Columbia University Medical Center, 630 West 168th Street, PH8-864, New York, NY 10032, USA.
| | | |
Collapse
|
49
|
Berman AR. Management of Patients with End-Stage Chronic Obstructive Pulmonary Disease. Prim Care 2011; 38:277-97, viii-ix. [DOI: 10.1016/j.pop.2011.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
50
|
Morden NE, Sullivan SD, Bartle B, Lee TA. Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures. Osteoporos Int 2011; 22:1855-62. [PMID: 20936402 PMCID: PMC3084349 DOI: 10.1007/s00198-010-1423-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 09/03/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED To advance our understanding of the burden of fractures among men, we studied a group of men at high risk for low bone strength due to lung disease. We found high rates of fractures but low rates of bone density testing that could predict fracture before it occurs. INTRODUCTION To advance understanding of the burden of fragility fractures and attention to bone health among men with chronic obstructive lung disease (COPD), we quantified rates of fragility fracture, bone density testing, and anti-resorptive treatment and calculated the number needed to screen (NNS) to prevent one hip fracture in a cohort of men with COPD. METHODS Veterans Administration (VA) and VA-Medicare administrative data permitted a retrospective cohort study of 87,360 men aged 50 and older, newly diagnosed with COPD between 1999 and 2003. Logistic regression models including patient characteristics, morbidities, and medication use assessed the effect of covariates on fracture and probability of testing or treatment. RESULTS Mean age was 66.8. Hip and wrist fracture rates were 3.99 and 1.31 per 1,000 person years, respectively. Mean follow-up was 2.67 years; 4.4% underwent bone densitometry; 2.8% filled anti-resorptive prescriptions. Age, white race/ethnicity, more COPD exacerbations, barbiturate use, and anti-Parkinson's drug use were significantly associated with fracture. Age, and systemic corticosteroids were most significantly associated with testing or treatment. Based on published adherence and treatment effects, the cohort's calculated NNS to prevent one hip fracture is 432. CONCLUSIONS Fracture rate was high and testing and treatment uncommon. The NNS of 432 to prevent one hip fracture is smaller than 731, the NNS for women aged 65-69 for whom universal screening is recommended. Attention to the bone health of this population is warranted. Future research must determine how testing and treatment impact overall quality of life and mortality of men with COPD.
Collapse
Affiliation(s)
- N E Morden
- The Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA.
| | | | | | | |
Collapse
|