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Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review. J Pers Med 2022; 12:jpm12101626. [PMID: 36294765 PMCID: PMC9604650 DOI: 10.3390/jpm12101626] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Osteoporosis is a highly prevalent condition affecting a growing number of patients affected by chronic obstructive pulmonary disease (COPD), with crucial implications for risk of fragility fractures, hospitalization, and mortality. Several risk factors have been identified to have a role in osteoporosis development in COPD patients, including corticosteroid therapy, systemic inflammation, smoke, physical activity levels, malnutrition, and sarcopenia. In this scenario, a personalized multitarget intervention focusing on the pathological mechanisms underpinning osteoporosis is mandatory to improve bone health in these frail patients. Specifically, physical exercise, nutritional approach, dietary supplements, and smoke cessation are the cornerstone of the lifestyle approach to osteoporosis in COPD patients, improving not only bone health but also physical performance and balance. On the other hand, pharmacological treatment should be considered for both the prevention and treatment of osteoporosis in patients at higher risk of fragility fractures. Despite these considerations, several barriers still affect the integration of a personalized approach to managing osteoporosis in COPD patients. However, digital innovation solutions and telemedicine might have a role in optimizing sustainable networking between hospital assistance and community settings to improve bone health and reduce sanitary costs of the long-term management of COPD patients with osteoporosis.
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Fernandez P, Pasqualini M, Locrelle H, Normand M, Bonneau C, Lafage Proust MH, Marotte H, Thomas T, Vico L. The effects of combined amplitude and high-frequency vibration on physically inactive osteopenic postmenopausal women. Front Physiol 2022; 13:952140. [PMID: 36160873 PMCID: PMC9491321 DOI: 10.3389/fphys.2022.952140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate whole-body vibration (WBV) osteogenic potential in physically inactive postmenopausal women using high-frequency and combined amplitude stimuli. Methods: Two-hundred fifty-five physically inactive postmenopausal women (55–75 years) with 10-year major osteoporotic fracture risk (3%–35%) participated in this 18-month study. For the first 12 months, the vibration group experienced progressive 20-min WBV sessions (up to 3 sessions/week) with rest periods (30–60 s) between exercises. Frequencies (30–50 Hz), with low (0.2–0.4 mm) and high (0.6–0.8 mm) amplitude stimuli were delivered via PowerPlate Pro5 platforms producing accelerations of (0.75–7.04 g). The last 6 months for the treatment group were a follow-up period similar to control. Serum bone remodelling markers [C-terminal crosslinked telopeptide of type-1 collagen (CTX), procollagen type-1 N-terminal propeptide (P1NP), bone alkaline phosphatase (BAP) and sclerostin] were measured at fasting. CTX and P1NP were determined by automated chemiluminescence immunoassay, bone alkaline phosphatase (BAP) by automated spectrophotometric immunoassay, and sclerostin by an enzyme-immunoassay. Bone mineral density (BMD) of the whole-body, proximal femur and lumbar vertebrae was measured by dual-energy X-ray absorptiometry (DXA). Bone microarchitecture of the distal non-dominant radius and tibia was measured by high-resolution peripheral quantitative computed tomography (HR-pQCT). Results: Femoral neck (p = 0.520) and spine BMD (p = 0.444) failed to improve after 12 months of WBV. Bone macro and microstructural parameters were not impacted by WBV, as well as estimated failure load at the distal radius (p = 0.354) and tibia (p = 0.813). As expected, most DXA and HR-pQCT parameters displayed age-related degradation in this postmenopausal population. BAP and CTX increased over time in both groups, with CTX more marginally elevated in the vibration group when comparing baseline changes to month-12 (480.80 pmol/L; p = 0.039) and month-18 (492.78 pmol/L; p = 0.075). However, no differences were found when comparing group concentrations only at month-12 (506.35 pmol/L; p = 0.415) and month-18 (518.33 pmol/L; p = 0.480), indicating differences below the threshold of clinical significance. Overall, HR-pQCT, DXA bone parameters and bone turnover markers remained unaffected. Conclusion: Combined amplitude and high-frequency training for one year had no ameliorating effect on DXA and HR-pQCT bone parameters in physically inactive postmenopausal women. Serum analysis did not display any significant improvement in formation and resorption markers and also failed to alter sclerostin concentrations between groups.
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Affiliation(s)
- Peter Fernandez
- SAINBIOSE, U1059, Laboratory of Osteoarticular Tissue Biology, INSERM, University of Lyon, Saint-Etienne, France
- *Correspondence: Peter Fernandez,
| | - Marion Pasqualini
- SAINBIOSE, U1059, Laboratory of Osteoarticular Tissue Biology, INSERM, University of Lyon, Saint-Etienne, France
| | - Hervé Locrelle
- Rheumatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Myriam Normand
- SAINBIOSE, U1059, Laboratory of Osteoarticular Tissue Biology, INSERM, University of Lyon, Saint-Etienne, France
| | - Christine Bonneau
- Biology and Pathology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Marie-Hélène Lafage Proust
- SAINBIOSE, U1059, Laboratory of Osteoarticular Tissue Biology, INSERM, University of Lyon, Saint-Etienne, France
- Rheumatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Hubert Marotte
- SAINBIOSE, U1059, Laboratory of Osteoarticular Tissue Biology, INSERM, University of Lyon, Saint-Etienne, France
- Rheumatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Thierry Thomas
- SAINBIOSE, U1059, Laboratory of Osteoarticular Tissue Biology, INSERM, University of Lyon, Saint-Etienne, France
- Rheumatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Laurence Vico
- SAINBIOSE, U1059, Laboratory of Osteoarticular Tissue Biology, INSERM, University of Lyon, Saint-Etienne, France
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