1
|
Jiang R, Mou S, Luo F, Zhang Z. Causal relationship between chronic obstructive pulmonary disease and BMD at different sites: A bidirectional Mendelian randomization study. Medicine (Baltimore) 2023; 102:e35495. [PMID: 37832103 PMCID: PMC10578729 DOI: 10.1097/md.0000000000035495] [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: 04/17/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
Observational studies have demonstrated a correlation between chronic obstructive pulmonary disease (COPD) and osteoporosis (OP). However, it is unclear whether there is genetic causality between COPD and bone mineral density (BMD) reduction at different sites. This study assessed the causal relationship between COPD and BMD in various anatomical locations. Data associated with COPD and BMD were obtained from published genome-wide association studies (GWAS). We selected single nucleotide polymorphisms (SNPs) that were strongly associated with COPD and BMD could serve as instrumental variables for the analysis. Inverse variance weighted, MR-Egger and weighted median were manipulated to evaluate causality. Subsequently, we conducted heterogeneity tests using Cochran Q test and tested for pleiotropy using the MR-Egger intercept. We performed leave-one-out sensitivity analysis to assess the robustness of the results. Additionally, we obtained more accurate causal genetic associations by removing any pleiotropic outlying SNPs and performed Mendelian randomization (MR) analysis with the remaining data. Our findings established that COPD was negatively associated with Heel-BMD (odds ratio[OR] = 0.978, 95% confidence interval [CI] = 0.966, 0.990, P = .0003) but not LS-BMD (OR = 0.981, 95% CI: 0.943, 1.020, P = .335), FA-BMD (OR = 0.984, 95% CI: 0.927, 1.046, P = .616), and FN-BMD (OR = 0.981, 95% CI: 0.950, 1.014, P = .249). In reverse MR analysis, the results showed no significant causal effect of BMD at different sites on COPD. The results were proved to be dependable and steady by sensitivity, heterogeneity, and pleiotropy analysis. We found that COPD increases the risk of decreased heel BMD, however, there is no evidence that the loss of BMD increases the risk of COPD.
Collapse
Affiliation(s)
- Rui Jiang
- College of Acupuncture and Orthopedics, Hubei University of Traditional Chinese Medicine, Wuhan, China
- Department of Orthopedics, Huanggang Hospital of Traditional Chinese Medicine affiliated with Hubei University of Chinese Medicine, Huanggang, China
| | - Shuanglin Mou
- Department of Orthopedics, Huanggang Hospital of Traditional Chinese Medicine affiliated with Hubei University of Chinese Medicine, Huanggang, China
| | - Feng Luo
- Department of Rehabilitation, Huanggang Central Hospital, Huanggang, China
| | - Zheng Zhang
- Department of Orthopedics, Huanggang Hospital of Traditional Chinese Medicine affiliated with Hubei University of Chinese Medicine, Huanggang, China
- School of Basic Medicine, Hubei University of Traditional Chinese Medicine, Wuhan, China
| |
Collapse
|
2
|
Kaenmuang P, Keeratichananont W, Geater SL, Chantamanee N, Srikaew P. Prevalence, predictors, dynamic bone change, and treatment efficacy of osteoporosis among chronic obstructive pulmonary disease patients: a prospective cohort study. Front Med (Lausanne) 2023; 10:1214277. [PMID: 37614952 PMCID: PMC10442549 DOI: 10.3389/fmed.2023.1214277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Background Osteoporosis is a silent chronic obstructive pulmonary disease (COPD) comorbidity that is often under-detected. We aimed to study the prevalence and potential predictors of osteoporosis in COPD. Dynamic changes in bone mass density (BMD) and treatment efficacy of bisphosphonate were also assessed. Methods This prospective cohort study included COPD patients between January 2017 and January 2019. Demographics data, spirometric parameters, and C-reactive protein (CRP) were collected. Bone mineral density (BMD) at the lumbar spine (L2-4) and both femoral necks were measured after enrollment and the 12-month follow-up. Participants were categorized into three groups per the baseline BMD T-score: normal (≥ - 1.0), osteopenia (between -1.0 and - 2.5), and osteoporosis (≤ - 2.5). In the osteoporosis group, alendronate 70 mg/week with vitamin D and calcium was prescribed. Results In total, 108 COPD patients were enrolled. The prevalence of osteoporosis and osteopenia were 31.5 and 32.4%, respectively. Advanced age, lower body mass index (BMI), history of exacerbation in the previous year, and high CRP levels were significant predictors of osteoporosis. After 12 months, 35.3% in the osteoporosis group reported new vertebral and femoral fractures, compared to none in the non-osteoporosis group (p < 0.001). In the normal BMD and osteopenia groups showed a further decline in BMD after 12-month. Conversely, the osteoporosis group showed a statistically significant improvement in BMD after anti-resorptive treatment (p < 0.001). Conclusion The prevalence of osteoporosis was high in Thai COPD patients. Advanced age, lower BMI, history of exacerbation, and high CRP levels were potential predictors. A rapid decline in BMD was observed in COPD patients without treatment.
Collapse
Affiliation(s)
- Punchalee Kaenmuang
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Warangkana Keeratichananont
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sarayut Lucien Geater
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Nicha Chantamanee
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Piyaporn Srikaew
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
3
|
Bitar AN, Sulaiman SAS. The evidence from clinical trials on colchicine and corticosteroids' effect on COVID-19: a systematic review and meta-analysis. Curr Med Res Opin 2022; 38:2097-2108. [PMID: 35819071 DOI: 10.1080/03007995.2022.2100654] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVES With no clear end for the outbreak, identifying the drugs that are effective in COVID-19's management is of utmost importance to reduce the impact on the general population and the healthcare systems. METHODS This is a systematic review and a meta-analysis evaluating the evidence from clinical trials on the effect of colchicine and corticosteroids against COVID-19. In this review, we have systematically searched five databases [(PubMed, Embase, clinicaltrials.gov, ICTRP, CINAHL (EBSCO)]. Cochrane's data extraction sheet was used to collect the required information, and RevMan-5.4.1 was used to conduct the meta-analysis and to assess the risk of bias. The review was registered in Prospero (CRD42022299718). RESULTS The total number of included studies was 17, with 18,956 participants; the majority were male 12,001. Out of which, 8772 participants were on colchicine, 569 took methylprednisolone, and 64 patients received prednisolone. The meta-analysis has shown that colchicine had no significant effect on reducing the mortality rate among COVID-19 patients [OR 0.98(95% CI 0.90-1.08), p = .70), I2:1%)], corticosteroids have significantly reduced the mortality rates [OR 0.55 (95% CI 0.33-0.91), p = .02, I2:40]. Colchicine did not reduce the incidence of ICU admissions [OR 0.74 (95% CI 0.39-1.40), p = .35, I2:0%], while steroidal drugs significantly reduced the ICU admissions [OR 0.42 (95% CI 0.23-0.78), p = .005, I2:0%]. Unlike steroidal drugs [OR 0.53 (95% CI 0.30-0.95), p = .03, I2:61%], colchicine failed to reduce the need for mechanical ventilation [OR 0.73 (95% CI 0.48-1.10), p = .13, I2:76%]. Steroidal drugs significantly reduced the duration of hospitalization among COVID-19 patients [OR -0.50 (95% CI -0.79-0.21), p = .0007, I2:36%]. CONCLUSIONS The use of colchicine did not significantly reduce the mortality rate, ICU admissions, and mechanical ventilation among COVID-19 patients. Conversely, corticosteroids significantly reduced the mortality rate, ICU admissions, mechanical ventilation, and hospitalization duration among COVID-19 patients.
Collapse
Affiliation(s)
- Ahmad Naoras Bitar
- Department of Clinical Pharmacy, Michel Sayegh College of Pharmacy, Aqaba University of Technology, South of Aqaba, Aqaba, Jordan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Malaysian Allied Health Sciences Academy, Jenjarom Selangor, Malaysia
| | - Syed Azhar Syed Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| |
Collapse
|
4
|
Akkaif MA, Bitar AN, Al-Kaif LAIK, Daud NAA, Sha’aban A, Noor DAM, Abd Aziz F, Cesaro A, SK Abdul Kader MA, Abdul Wahab MJ, Khaw CS, Ibrahim B. The Management of Myocardial Injury Related to SARS-CoV-2 Pneumonia. J Cardiovasc Dev Dis 2022; 9:jcdd9090307. [PMID: 36135452 PMCID: PMC9503627 DOI: 10.3390/jcdd9090307] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 02/07/2023] Open
Abstract
The global evolution of the SARS-CoV-2 virus is known to all. The diagnosis of SARS-CoV-2 pneumonia is expected to worsen, and mortality will be higher when combined with myocardial injury (MI). The combination of novel coronavirus infections in patients with MI can cause confusion in diagnosis and assessment, with each condition exacerbating the other, and increasing the complexity and difficulty of treatment. It would be a formidable challenge for clinical practice to deal with this situation. Therefore, this review aims to gather literature on the progress in managing MI related to SARS-CoV-2 pneumonia. This article reviews the definition, pathogenesis, clinical evaluation, management, and treatment plan for MI related to SARS-CoV-2 pneumonia based on the most recent literature, diagnosis, and treatment trial reports. Many studies have shown that early diagnosis and implementation of targeted treatment measures according to the different stages of disease can reduce the mortality rate among patients with MI related to SARS-CoV-2 pneumonia. The reviewed studies show that multiple strategies have been adopted for the management of MI related to COVID-19. Clinicians should closely monitor SARS-CoV-2 pneumonia patients with MI, as their condition can rapidly deteriorate and progress to heart failure, acute myocardial infarction, and/or cardiogenic shock. In addition, appropriate measures need to be implemented in the diagnosis and treatment to provide reasonable care to the patient.
Collapse
Affiliation(s)
- Mohammed Ahmed Akkaif
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Malaysia
| | - Ahmad Naoras Bitar
- Department of Clinical Pharmacy, Michel Sayegh College of Pharmacy, Aqaba University of Technology, South of Aqaba, South Beach Road, Opposite Aqaba Development Corporation Stores, Aqaba 910122, Jordan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Malaysian Allied Health Sciences Academy, Jalan SP 2, Bandar Saujana Putra, Jenjarom 42610, Malaysia
| | - Laith A. I. K. Al-Kaif
- Department of Medical Laboratory Techniques, Al Mustaqbal University College, Hillah 51001, Babylon, Iraq
| | - Nur Aizati Athirah Daud
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Malaysia
- Correspondence: (N.A.A.D.); (B.I.)
| | - Abubakar Sha’aban
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4YS, UK
| | | | | | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | | | | | - Chee Sin Khaw
- Department of Cardiology, Penang General Hospital, George Town 10990, Malaysia
| | - Baharudin Ibrahim
- Faculty of Pharmacy, University of Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence: (N.A.A.D.); (B.I.)
| |
Collapse
|
5
|
Ma Y, Qiu S, Zhou R. Osteoporosis in Patients With Respiratory Diseases. Front Physiol 2022; 13:939253. [PMID: 35903070 PMCID: PMC9315364 DOI: 10.3389/fphys.2022.939253] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Climate change, environmental pollution, and virus epidemics have sharply increased the number of patients suffering from respiratory diseases in recent years. Prolonged periods of illness and drug use increase the occurrence of complications in these patients. Osteoporosis is the common bone metabolism disease with respiratory disturbance, which affects prognosis and increases mortality of patients. The problem of osteoporosis in patients with respiratory diseases needs more attention. In this review, we concluded the characteristics of osteoporosis in some respiratory diseases including COPD, asthma, COVID-19, tuberculosis, and lung cancer. We revealed that hypoxia was the common pathogenesis of osteoporosis secondary to respiratory diseases, with malnutrition and corticosteroid abuse driving the progression of osteoporosis. Hypoxia-induced ROS accumulation and activated HIF-1α lead to attenuated osteogenesis and enhanced osteoclastogenesis in patients with respiratory diseases. Tuberculosis and cancer also invaded bone tissue and reduced bone strength by direct infiltration. For the treatment of osteoporosis in respiratory patients, oral-optimized bisphosphonates were the best treatment modality. Vitamin D was a necessary supplement, both for calcium absorption in osteogenesis and for improvement of respiratory lesions. Reasonable adjustment of the dose and course of corticosteroids according to the etiology and condition of patients is beneficial to prevent the occurrence and development of osteoporosis. Additionally, HIF-1α was a potential target for the treatment of osteoporosis in respiratory patients, which could be activated under hypoxia condition and involved in the process of bone remodeling.
Collapse
Affiliation(s)
- Yue Ma
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shui Qiu
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
| | - Renyi Zhou
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
- *Correspondence: Renyi Zhou,
| |
Collapse
|
6
|
Bitar SM, Moussa M. The risk factors for the recurrent upper gastrointestinal hemorrhage among acute peptic ulcer disease patients in Syria: A prospective cohort study. Ann Med Surg (Lond) 2022; 74:103252. [PMID: 35106151 PMCID: PMC8784635 DOI: 10.1016/j.amsu.2022.103252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a life-threatening medical emergency characterized by bleeding from the esophagus, stomach, or duodenum. This study aims to analyze the risk factors for upper gastrointestinal tract rebleeding among acute peptic ulcer patients. METHODS This is a cohort clinical study conducted between July 2018 and June 2020. Patients admitted or hospitalized because of UGIB or developed it during their hospital stay were included.s The patients were divided into two groups for the statistical analysis using Forrest's ulcer rebleeding risk classification. Group 1: Forrest 1a+1b+2a+2b, and group 2: Forrest 2c+3. The fasting time before the endoscopic procedure was from 12 to 24 hours. Follow-ups were conducted for 30 days after the treatment. RESULTS The total number of included subjects was 152, out of which 57.89% (n = 88) were male patients. The mean SD for patients' age was 52.63 16.89±; more than 40% (n = 62) of subjects were using antiplatelet medications, while only 13.15% (n = 20) used NSAIDs, and the mean SD for the transferred units was 2.32 ± 1.88, 7.24% (n = 11) of patients died. After 30 days of the treatment, 6.57% (n = 10) of patients suffered from recurrent bleeding. The most common presentation was melena 67.95% (n = 103), 53% (n = 81) of patients had hematemesis, 69.73% (n = 106) patients had gastric ulcer and 30.26% (n = 46) had duodenal ulcers. CONCLUSION Age, NSAIDs, altered mental capacity, Forrest classification (Ia,Ib, and IIa), and blood transfusion were associated with a higher risk of rebleeding. Furthermore, patients who needed 3.83 blood units were at higher risk of recurrent bleeding.
Collapse
Affiliation(s)
- Sara Mona Bitar
- Department of Gastroenterology, Faculty of Medicine, University of Aleppo, Syria
| | - Maen Moussa
- Department of Gastroenterology, Faculty of Medicine, University of Aleppo, Syria
| |
Collapse
|