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Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev 2022; 43:240-313. [PMID: 34476488 DOI: 10.1210/endrev/bnab028] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a global public health problem, with fractures contributing to significant morbidity and mortality. Although postmenopausal osteoporosis is most common, up to 30% of postmenopausal women, > 50% of premenopausal women, and between 50% and 80% of men have secondary osteoporosis. Exclusion of secondary causes is important, as treatment of such patients often commences by treating the underlying condition. These are varied but often neglected, ranging from endocrine to chronic inflammatory and genetic conditions. General screening is recommended for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and men aged < 50 years, for older patients in whom classical risk factors for osteoporosis are absent, and for all patients with the lowest bone mass (Z-score ≤ -2). The response of secondary osteoporosis to conventional anti-osteoporosis therapy may be inadequate if the underlying condition is unrecognized and untreated. Bone densitometry, using dual-energy x-ray absorptiometry, may underestimate fracture risk in some chronic diseases, including glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, and may overestimate fracture risk in others (eg, Turner syndrome). FRAX and trabecular bone score may provide additional information regarding fracture risk in secondary osteoporosis, but their use is limited to adults aged ≥ 40 years and ≥ 50 years, respectively. In addition, FRAX requires adjustment in some chronic conditions, such as glucocorticoid use, type 2 diabetes, and HIV. In most conditions, evidence for antiresorptive or anabolic therapy is limited to increases in bone mass. Current osteoporosis management guidelines also neglect secondary osteoporosis and these existing evidence gaps are discussed.
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Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria 3011, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Phillip Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
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2
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Serum Albumin Concentrations in Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10020269. [PMID: 33450916 PMCID: PMC7828417 DOI: 10.3390/jcm10020269] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/20/2020] [Accepted: 01/08/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by chronic airway inflammation and lung parenchyma damage. Systemic inflammation and oxidative stress also play a role in the pathogenesis of COPD. Serum albumin is a negative acute-phase protein with antioxidant effects and an important marker of malnutrition. The aim of this meta-analysis was to investigate differences in serum albumin concentrations between patients with stable COPD and non-COPD subjects. Methods: A systematic search was conducted, using the terms “albumin” and “chronic obstructive pulmonary disease” or “COPD”, in the electronic databases PubMed and Web of Science, from inception to May 2020. Results: Twenty-six studies were identified on a total of 2554 COPD patients and 2055 non-COPD controls. Pooled results showed that serum albumin concentrations were significantly lower in COPD patients (standard mean difference, SMD = −0.50, 95% CI −0.67 to −0.32; p < 0.001). No significant differences were observed in SMD of serum albumin concentrations between COPD patients with forced expiratory volume in the 1st second (FEV1) < 50% and those with FEV1 > 50%. Conclusions: Our systematic review and meta-analysis showed that serum albumin concentrations are significantly lower in patients with stable COPD compared to non-COPD controls. This supports the presence of a deficit in systemic anti-inflammatory and antioxidant defense mechanisms in COPD.
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Lee JW, Cho HE, Kang SW, Choi WA, Suh MR, Kim B. Correlation of Bone Mineral Density with Pulmonary Function in Advanced Duchenne Muscular Dystrophy. PM R 2020; 13:166-170. [PMID: 32306557 DOI: 10.1002/pmrj.12386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND A relationship between bone mineral density (BMD) and physical function has been revealed in the general population and various diseases. However, there is a lack of research investigating the correlation between BMD and respiratory function, one of few measurable physical parameters in patients with advanced Duchenne muscular dystrophy (DMD). OBJECTIVE To determine whether pulmonary function parameters, including respiratory muscle strength, are related to BMD. DESIGN Retrospective observational study. SETTING A tertiary university hospital. PATIENTS DMD patients who were over 20 years of age, nonambulatory, and supported by mechanical ventilators. METHODS The patients' age, weight, and pulmonary function as well as the BMD of the first and the fourth lumbar vertebra were assessed. Pulmonary function includes forced vital capacity (FVC), unassisted and assisted peak cough flow (UPCF and APCF), maximal expiratory pressure (MEP), and maximal inspiratory pressure (MIP). MAIN OUTCOME MEASURES A bivariate correlation for BMD and other pulmonary parameters was calculated, and hierarchical regression analysis was used to determine predictors of spine Z-score. RESULTS It was observed that the decrease in the spine BMD was not significantly correlated with age. However, the body mass index (BMI) and all parameters of pulmonary function were correlated with BMD. Partial correlation analysis adjusted by BMI showed that UPCF and APCF were powerful predictors of spine BMD. CONCLUSIONS The BMD of the lumbar spine correlated with BMI and PCF in patients with DMD at an advanced stage.
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Affiliation(s)
- Jang Woo Lee
- Department of Medicine, The Graduate School, Yonsei University, Seoul, South Korea.,Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Han Eol Cho
- Department of Medicine, The Graduate School, Yonsei University, Seoul, South Korea.,Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong-Woong Kang
- Department of Medicine, The Graduate School, Yonsei University, Seoul, South Korea.,Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Ah Choi
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Mi Ri Suh
- Department of Physical Medicine and Rehabilitation, CHA University, Seongnam, South Korea
| | - Bitnarae Kim
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea.,Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, South Korea
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4
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Chen YW, Ramsook AH, Coxson HO, Bon J, Reid WD. Prevalence and Risk Factors for Osteoporosis in Individuals With COPD: A Systematic Review and Meta-analysis. Chest 2019; 156:1092-1110. [PMID: 31352034 DOI: 10.1016/j.chest.2019.06.036] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/10/2019] [Accepted: 06/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Osteoporosis is prevalent in individuals with COPD. Updated evidence is required to complement the previous systematic review on this topic to provide best practice. The aim of this systematic review and meta-analysis was to quantitatively synthesize data from studies with respect to the prevalence and risk factors for osteoporosis among individuals with COPD. METHODS EMBASE, CINAHL, MEDLINE, and PubMed databases were searched for articles containing the key words "COPD," "osteoporosis," "prevalence," and "risk factor." Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine osteoporosis prevalence and risk factors in individuals with COPD. Meta-regression analyses were conducted to explore the sources of heterogeneity. RESULTS The pooled global prevalence from 58 studies was 38% (95% CI, 34-43). The presence of COPD increased the likelihood of having osteoporosis (OR, 2.83). Other significant risk factors for osteoporosis in COPD patients were BMI < 18.5 kg/m2 (OR, 4.26) and the presence of sarcopenia (OR, 3.65). CONCLUSIONS Osteoporosis is prevalent in individuals with COPD, and the prevalence seems to be high and similar in many countries. Patients with COPD should be screened for osteoporosis and contributing risk factors.
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Affiliation(s)
- Yi-Wen Chen
- Department of Sports Medicine, China Medical University, Taichung, Taiwan.
| | - Andrew H Ramsook
- Department of Physical Therapy, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Harvey O Coxson
- Department of Radiology, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - W Darlene Reid
- Department of Physical Therapy, Faculty of Medicine, Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; KITE - Toronto Rehab-University Health Network, Toronto, ON, Canada
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5
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Guilleminault L, Rolland Y, Didier A. [Characteristics of non-pharmacological interventions in the elderly with COPD. Smoking cessation, pulmonary rehabilitation, nutritional management and patient education]. Rev Mal Respir 2018; 35:626-641. [PMID: 29937313 DOI: 10.1016/j.rmr.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/16/2017] [Indexed: 01/15/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a respiratory disorder responsible for a high mortality and disability. People older than 65 years are more commonly affected than younger people and tend to present with more symptoms and a greater level of disability. Non-pharmacological interventions play an important role in the management of all patients with COPD and this is particularly true in the elderly. Given the improvement in quality of life and risk of hospitalization, smoking cessation should be promoted to patients of all ages. Increased physical activity is associated with reduced respiratory symptoms. Tests such as the "Short Physical Performance Battery" can be useful in frailer older people with COPD, while walking tests such as the 6-minute walk test are used as an assessment before pulmonary rehabilitation. Increased physical activity should be combined with nutritional management. Screening for undernutrition by questionnaire, body mass index and albumin quantification is recommended in the elderly. In case of undernutrition, oral supplementation seems to reduce the risk of re-admission. All these measures must be included in an education program adapted to the elderly comorbidities (hearing loss, isolation…).
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Affiliation(s)
- L Guilleminault
- Airway center, Larrey hospital, CHU de Toulouse, 31059 Toulouse, France; STROMALab, université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, 31100 Toulouse, France.
| | - Y Rolland
- Gerontopole, CHU de Toulouse, 31059 Toulouse, France; UMR Inserm 1027, université de Toulouse III, 31000 Toulouse, France
| | - A Didier
- Airway center, Larrey hospital, CHU de Toulouse, 31059 Toulouse, France
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6
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Lu PC, Yang YH, Guo SE, Yang TM. Factors associated with osteoporosis in patients with chronic obstructive pulmonary disease-a nationwide retrospective study. Osteoporos Int 2017; 28:359-367. [PMID: 27519532 DOI: 10.1007/s00198-016-3732-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 08/01/2016] [Indexed: 01/25/2023]
Abstract
UNLABELLED The present study aimed to identify the factors associated with osteoporosis in patients with chronic obstructive pulmonary disease in Taiwan. The study found that female sex, old age, and use of a high dose of oral corticosteroids were significantly associated with osteoporosis in these patients. INTRODUCTION Chronic obstructive pulmonary disease (COPD) is becoming an increasingly serious and prevalent issue worldwide. The treatment of COPD with long-term steroid use may cause osteoporosis and have significant influences on disability and mortality. However, few studies have evaluated the association between steroid use and osteoporosis in patients with COPD. The present study aimed to identify the factors, including demographic characteristics and steroid use (oral corticosteroids [OCSs], inhaled corticosteroids, and injected steroids), associated with osteoporosis in patients with COPD in Taiwan. METHODS This was a retrospective case-control study. Data were obtained from the National Health Insurance Research Database from 1997 to 2009. Cox proportional hazard regression models were used to identify the factors associated with osteoporosis. RESULTS The incidence of osteoporosis in the patients with COPD was 1343.0 per 100,000 person-years, the majority of patients were women (63.6 %), and the mean age of the patients was 72.5 years. In multivariate regression analysis, female sex, old age, and use of a high OCS dose with a defined daily dose (DDD) >56 (hazard ratio 1.85, 95 % confidence interval 1.52-2.26, P < .0001) exhibited significant independent associations with osteoporosis. CONCLUSIONS Female sex, old age, and use of a high OCS dose with a cumulative DDD >56 are associated with osteoporosis in patients with COPD. Additionally, female patients >50 years old and male patients >70 years old have a higher risk of osteoporosis. Medical personnel should actively provide health education for the prevention of osteoporosis in these patients.
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Affiliation(s)
- P-C Lu
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan (Republic of China)
| | - Y-H Yang
- Department of Traditional Chinese Medicine and Center of Excellence for Chang Gung Research Datalink, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan (Republic of China)
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, 1, Sec. 4, Roosevelt Rd., Zhongzheng Dist., Taipei City, 10617, Taiwan (Republic of China)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan (Republic of China)
| | - S-E Guo
- Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, 2, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan (Republic of China).
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, 2, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan (Republic of China).
- Division of Pulmonary and Critical Care Medicine, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61636, Taiwan (Republic of China).
| | - T-M Yang
- Division of Pulmonary and Critical Care Medicine, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61636, Taiwan (Republic of China)
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7
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Kochetkova EA, Nevzorova VA, Ugai LG, Maistrovskaia YV, Massard G. The Role of Tumor Necrosis Factor Alpha and TNF Superfamily Members in Bone Damage in Patients with End-Stage Chronic Obstructive Lung Disease Prior to Lung Transplantation. Calcif Tissue Int 2016; 99:578-587. [PMID: 27501819 DOI: 10.1007/s00223-016-0185-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/01/2016] [Indexed: 11/25/2022]
Abstract
A disequilibrium of tumor necrosis superfamily (TNF) members, including the serum osteoprotegerin, soluble receptor activator of nuclear factor-κB ligand, soluble TNF-related apoptosis-inducing ligand and TNF-α, was associated with the occurrence of a reduced skeletal mass and osteoporosis in male patients with end-stage chronic obstructive pulmonary disease (COPD). The purpose of this study was to explore the associations between serum biomarkers of tumor necrosis factor (TNF) superfamily and body and bone compositions in end-stage COPD males. Pulmonary function, T-score at the lumbar spine and femoral neck, lean mass, serum osteoprotegerin (OPG), soluble receptor activator of nuclear factor-κB ligand (sRANKL), TNF-α and its receptors (sTNFR-I, sTNFR-II) and soluble TNF-related apoptosis-inducing ligand (sTRAIL) levels were evaluated in 48 male patients with end-stage COPD and 36 healthy male volunteers. OPG was lower in male COPD patients than in control subjects, whereas sRANKL, TNF-α and its receptors were higher. The serum sTRAIL level showed a tendency to increase compared with that of healthy subjects (P = 0.062). Serum OPG showed a positive correlation with bone density. In contrast, serum TNF-α, sRANKL and sTRAIL were inversely associated with pretransplant bone density. We have noted the appearance of statistically significant inverse relationships between lean mass values and TNF-α, sTNFR-I and II and sRANKL levels in male COPD patients. Moreover, there was a negative correlation between sTRAIL levels with airway obstruction (P = 0.005) and hypercapnia (P = 0.042) in advanced COPD patients. Through a multiple linear regression analysis, our study revealed that a disequilibrium of TNF family members was strongly associated with the occurrence of a reduced skeletal mass and osteoporosis. These results provide further evidence that abnormal levels of TNF superfamily molecules may cause not only a decrease in BMD, but also lower muscle mass in end-stage COPD.
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Affiliation(s)
- Evgenia A Kochetkova
- Central Scientific Research Laboratory, Pacific State Medical University, 2 Ostryakova Av., Vladivostok, Russian Federation, 690950.
| | - Vera A Nevzorova
- Central Scientific Research Laboratory, Pacific State Medical University, 2 Ostryakova Av., Vladivostok, Russian Federation, 690950
| | - Ludmila G Ugai
- Central Scientific Research Laboratory, Pacific State Medical University, 2 Ostryakova Av., Vladivostok, Russian Federation, 690950
| | - Yulia V Maistrovskaia
- Central Scientific Research Laboratory, Pacific State Medical University, 2 Ostryakova Av., Vladivostok, Russian Federation, 690950
| | - Gilbert Massard
- Department of Pulmonology, Allergy and Thoracic Surgery, Faculty of Medicine, University of Strasbourg, Strasbourg, France
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8
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The Association Between Bone Mineral Density and Airflow Limitation in a Cohort of Fit Elderly Women. Lung 2016; 194:897-904. [PMID: 27699476 DOI: 10.1007/s00408-016-9948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE As studies examining the association between bone mineral density (BMD) and airflow limitation (AL) have produced conflicting results, the current one set out to analyze if and to what degree there are any correlations between these variables in a population of fit elderly women. METHODS One hundred and twenty-one non-smoking, fit and healthy women (age ≥ 65 years) underwent anthropometric assessment, laboratory testing (serum 25-hydroxy vitamin D, parathormone, and cytokine levels), pulmonary function testing (PFT), and dual-energy X-ray absorptiometry to evaluate BMD values of the lumbar and femoral regions. RESULTS A significant positive association was found between FEV1/FVC ratio (Tiffeneau index), a sensitive index of AL, and lumbar and femoral BMD; a 10 % increase in the FEV1/FVC ratio resulted in a significant increase of 0.025 g/cm2 in the total hip (p = 0.05), 0.027 g/cm2 in the femoral neck (p = 0.02), 0.028 g/cm2 in the femoral trochanter (p = 0.01), and 0.047 g/cm2 in the lumbar (p = 0.03) BMDs. Binary logistic analyses demonstrated more than a threefold higher risk of low BMD values for the lowest FEV1/FVC quartile in the lumbar (OR 4.62, 95 % CI 1.48-14.40, p = 0.008), total hip (OR 4.09, 95 % CI 1.28-13.05, p = 0.02 for the second quartile), and femoral trochanter regions (OR 3.90, 95 % CI 1.25-12.20, p = 0.02 for the third quartile). CONCLUSIONS AL was associated with a higher risk of reduced BMD in healthy, fit elderly women.
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9
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Corlateanu A, Covantev S, Mathioudakis AG, Botnaru V, Siafakas N. Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease. Respir Investig 2016; 54:387-396. [PMID: 27886849 DOI: 10.1016/j.resinv.2016.07.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/01/2016] [Indexed: 02/08/2023]
Abstract
The classical definition of Chronic Obstructive Pulmonary Disease (COPD) as a lung condition characterized by irreversible airway obstruction is outdated. The systemic involvement in patients with COPD, as well as the interactions between COPD and its comorbidities, justify the description of chronic systemic inflammatory syndrome. The pathogenesis of COPD is closely linked with aging, as well as with cardiovascular, endocrine, musculoskeletal, renal, and gastrointestinal pathologies, decreasing the quality of life of patients with COPD and, furthermore, complicating the management of the disease. The most frequently described comorbidities include skeletal muscle wasting, cachexia (loss of fat-free mass), lung cancer (small cell or non-small cell), pulmonary hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, normocytic anemia, diabetes, metabolic syndrome, osteoporosis, obstructive sleep apnea, depression, and arthritis. These complex interactions are based on chronic low-grade systemic inflammation, chronic hypoxia, and multiple common predisposing factors, and are currently under intense research. This review article is an overview of the comorbidities of COPD, as well as their interaction and influence on mutual disease progression, prognosis, and quality of life.
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Affiliation(s)
- Alexandru Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Stefan cel Mare Street 165, 2004 Chisinau, Republic of Moldova.
| | - Serghei Covantev
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Stefan cel Mare Street 165, 2004 Chisinau, Republic of Moldova.
| | - Alexander G Mathioudakis
- Chest Centre, Aintree University Hospitals NHS Foundation Trust, Langmoor Lane, Liverpool, Merseyside L9 7AL, United Kingdom.
| | - Victor Botnaru
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Stefan cel Mare Street 165, 2004 Chisinau, Republic of Moldova.
| | - Nikolaos Siafakas
- University General Hospital, Department of Thoracic Medicine, Stavrakia, 71110 Heraklion, Crete, Greece.
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10
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Sarcopenia as an Independent Risk Factor for Decreased BMD in COPD Patients: Korean National Health and Nutrition Examination Surveys IV and V (2008-2011). PLoS One 2016; 11:e0164303. [PMID: 27749901 PMCID: PMC5066961 DOI: 10.1371/journal.pone.0164303] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/22/2016] [Indexed: 11/19/2022] Open
Abstract
Background A decrease in bone mineral density (BMD) is a systemic consequence of chronic obstructive pulmonary disease (COPD). Past reports have rarely examined any correlation between sarcopenia and BMD. We investigated the relationship cross-sectionally between the presence of sarcopenia and BMD reduction in COPD patients. Methods COPD patients aged 50 or older with qualifying spirometry and dual-energy X-ray absorptiometry data were from participants in the Korean National Health and Nutrition Examination Surveys IV and V (2008–2011). Results There were 286 (33.3%) subjects in the sarcopenia group and 572 (66.7%) in the non-sarcopenia group. The sarcopenia group had lower T-scores than the non-sarcopenia group (femur: -0.73±0.88 vs. -0.18±0.97, p < 0.001; femur neck: -1.44±0.98 vs. -0.99±1.06, p < 0.001; lumbar: -1.38±1.36 vs. -0.84±1.38, p < 0.001). The prevalences of osteopenia and osteoporosis were 60.8% and 22.0%, respectively, in the sarcopenia group and 45.6% and 13.3% in the non-sarcopenia group (both p < 0.001). After adjusting for multiple variables, the presence of sarcopenia associated with increased the risk of osteopenia, osteoporosis, and a low BMD (OR = 3.227, 95% CI = 2.125–4.899, p < 0.001, OR = 6.952, 95% CI = 3.418–14.139, p < 0.001, and OR = 3.495, 95% CI = 2.315–5.278, p < 0.001, respectively). In a subgroup analysis, similar OR changes were confirmed in the high-body-weight group (n = 493) (OR = 2.248, 95% CI = 1.084–4.665, p = 0.030, OR = 4.621, 95% CI = 1.167–18.291, p = 0.029, and OR = 2.376, 95% CI = 1.158–4.877, p = 0.018, respectively). Conclusions The presence of sarcopenia was associated with increased the risk for decreased BMD in COPD.
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Liu WT, Kuo HP, Liao TH, Chiang LL, Chen LF, Hsu MF, Chuang HC, Lee KY, Huang CD, Ho SC. Low bone mineral density in COPD patients with osteoporosis is related to low daily physical activity and high COPD assessment test scores. Int J Chron Obstruct Pulmon Dis 2015; 10:1737-44. [PMID: 26366066 PMCID: PMC4562728 DOI: 10.2147/copd.s87110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
COPD patients have an increased prevalence of osteoporosis (OP) compared with healthy people. Physical inactivity in COPD patients is a crucial risk factor for OP; the COPD assessment test (CAT) is the newest assessment tool for the health status and daily activities of COPD patients. This study investigated the relationship among daily physical activity (DPA), CAT scores, and bone mineral density (BMD) in COPD patients with or without OP. This study included 30 participants. Ambulatory DPA was measured using actigraphy and oxygen saturation by using a pulse oximeter. BMD was measured using dual-energy X-ray absorptiometry. OP was defined as a T-score (standard deviations from a young, sex-specific reference mean BMD) less than or equal to −2.5 SD for the lumbar spine, total hip, and femoral neck. We quantified oxygen desaturation during DPA by using a desaturation index and recorded all DPA, except during sleep. COPD patients with OP had lower DPA and higher CAT scores than those of patients without OP. DPA was significantly positively correlated with (lumbar spine, total hip, and femoral neck) BMD (r=0.399, 0.602, 0.438, respectively, all P<0.05) and T-score (r=0.471, 0.531, 0.459, respectively, all P<0.05), whereas CAT scores were significantly negatively correlated with (total hip and femoral neck) BMD (r=−0.412, −0.552, respectively, P<0.05) and (lumbar spine, total hip, and femoral neck) T-score (r=−0.389, −0.429, −0.543, respectively, P<0.05). Low femoral neck BMD in COPD patients was related to high CAT scores. Our results show no significant difference in desaturation index, low SpO2, and inflammatory markers (IL-6, TNF-α, IL-8/CXCL8, CRP, and 8-isoprostane) between the two groups. Chest physicians should be aware that COPD patients with OP have low DPA and high CAT scores.
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Affiliation(s)
- Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan ; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Pin Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Tien-Hua Liao
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Ling-Ling Chiang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fei Chen
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Min-Fang Hsu
- Department of Healthcare Administration, Asia University, Wufeng, Taichung
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan ; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Da Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Shu-Chuan Ho
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
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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.
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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
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Morley JE. Chronic obstructive pulmonary disease: a disease of older persons. J Am Med Dir Assoc 2014; 15:151-153. [PMID: 24513223 DOI: 10.1016/j.jamda.2013.12.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
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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.
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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
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15
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Kim S, Won CW, Kim BS, Choi HR, Moon MY. The association between the low muscle mass and osteoporosis in elderly Korean people. J Korean Med Sci 2014; 29:995-1000. [PMID: 25045234 PMCID: PMC4101790 DOI: 10.3346/jkms.2014.29.7.995] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/24/2014] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to predict osteoporosis risk as decreasing muscle mass and to declare the cut-off value of low muscle mass in an elderly Korean population. This study was based on data from the 2008-2010 Korea National Health and Nutritional Examination Surveys (KNHANES). The subjects included 1,308 men and 1,171 women over 65 yr. Bone mineral density (BMD) and appendicular skeletal muscle (ASM) were measured by dual energy X-ray absorptiometry (DXA), and appendicular skeletal muscle was adjusted by height as a marker of sarcopenia. After confirming the correlation between low muscle mass and BMD, the best cut-off value of muscle mass to estimate osteoporosis was suggested through the receiver operating characteristic (ROC) curve. For both men and women, BMD correlated positively with low muscle mass when ASM/Ht(2) was used as a marker for sarcopenia. The ROC curve showed that ASM/Ht(2) was the best marker for osteoporosis at a cut-off value of 6.85 kg/m(2) for men and 5.96 kg/m(2) for women. When these cut-off values were used to determine sarcopenia, the risk of osteoporosis increased 4.14 times in men and 1.88 times in women. In particular, men (OR 2.12) with sarcopenia were more greatly affected than women (OR 1.15), even after adjusting for osteoporosis risk factors. In elderly Korean people, sarcopenia is positively correlated with BMD and there is a strong correlation between sarcopenia and osteoporosis with risk of bone fracture.
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Affiliation(s)
- Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Medicine, Graduate School Ewha Womans University, Seoul, Korea
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Byung Sung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Rim Choi
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Min Young Moon
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
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Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigaré R, Dekhuijzen PNR, Franssen F, Gayan-Ramirez G, Gea J, Gosker HR, Gosselink R, Hayot M, Hussain SNA, Janssens W, Polkey MI, Roca J, Saey D, Schols AMWJ, Spruit MA, Steiner M, Taivassalo T, Troosters T, Vogiatzis I, Wagner PD. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014; 189:e15-62. [PMID: 24787074 DOI: 10.1164/rccm.201402-0373st] [Citation(s) in RCA: 692] [Impact Index Per Article: 69.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Limb muscle dysfunction is prevalent in chronic obstructive pulmonary disease (COPD) and it has important clinical implications, such as reduced exercise tolerance, quality of life, and even survival. Since the previous American Thoracic Society/European Respiratory Society (ATS/ERS) statement on limb muscle dysfunction, important progress has been made on the characterization of this problem and on our understanding of its pathophysiology and clinical implications. PURPOSE The purpose of this document is to update the 1999 ATS/ERS statement on limb muscle dysfunction in COPD. METHODS An interdisciplinary committee of experts from the ATS and ERS Pulmonary Rehabilitation and Clinical Problems assemblies determined that the scope of this document should be limited to limb muscles. Committee members conducted focused reviews of the literature on several topics. A librarian also performed a literature search. An ATS methodologist provided advice to the committee, ensuring that the methodological approach was consistent with ATS standards. RESULTS We identified important advances in our understanding of the extent and nature of the structural alterations in limb muscles in patients with COPD. Since the last update, landmark studies were published on the mechanisms of development of limb muscle dysfunction in COPD and on the treatment of this condition. We now have a better understanding of the clinical implications of limb muscle dysfunction. Although exercise training is the most potent intervention to address this condition, other therapies, such as neuromuscular electrical stimulation, are emerging. Assessment of limb muscle function can identify patients who are at increased risk of poor clinical outcomes, such as exercise intolerance and premature mortality. CONCLUSIONS Limb muscle dysfunction is a key systemic consequence of COPD. However, there are still important gaps in our knowledge about the mechanisms of development of this problem. Strategies for early detection and specific treatments for this condition are also needed.
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Romme EAPM, Smeenk FWJM, Rutten EPA, Wouters EFM. Osteoporosis in chronic obstructive pulmonary disease. Expert Rev Respir Med 2013; 7:397-410. [PMID: 23952337 DOI: 10.1586/17476348.2013.814402] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is being regarded as a heterogeneous disease with clinically significant pulmonary and extrapulmonary manifestations, such as emphysema, cardiovascular disease and osteoporosis. Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and, consequently, an increased risk of fracture. Fractures resulting from osteoporosis might contribute to increased morbidity and mortality, particularly in COPD patients. The high prevalence of osteoporosis in COPD patients is assumed to be due to common risk factors, such as older age and tobacco smoking, and COPD-specific risk factors, such as systemic inflammation, vitamin D deficiency and the use of oral or inhaled corticosteroids. This review provides a state-of-the-art summary of the prevalence, pathophysiology, diagnosis, risk factors and treatment of osteoporosis in COPD patients. It also discusses potential mechanisms linking COPD with osteoporosis.
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Affiliation(s)
- Elisabeth A P M Romme
- Catharina Hospital, Department of Respiratory Medicine, PO Box 1350, 5602 ZA Eindhoven, The Netherlands.
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Current world literature. Curr Opin Pulm Med 2011; 17:126-30. [PMID: 21285709 DOI: 10.1097/mcp.0b013e3283440e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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