The Risk of Osteoporosis in Patients With COPD

January 1, 2007

Patients with COPD are at greater risk for osteopeniaand osteoporosis than persons who do not haveCOPD. Studies have reported osteopenia in 35% to 72%and osteoporosis in 36% to 60% of patients with COPD.1,2

Q:To what extent are patients with chronicobstructive pulmonary disease (COPD) atincreased risk for osteoporosis? What preventivestrategies do you recommend?
A:Patients with COPD are at greater risk for osteopeniaand osteoporosis than persons who do not haveCOPD. Studies have reported osteopenia in 35% to 72%and osteoporosis in 36% to 60% of patients with COPD.1,2Risk factors. These include age, sex (more womenhave advanced COPD than men), family history, physicalinactivity, smoking, vitamin D deficiency, and low bodymass index. The use of corticosteroids, particularly systemiccorticosteroids, also increases risk. Even inhaledcorticosteroid use has been associated with acceleratedloss of bone mineral density (BMD)3; the risk appears tobe greatest in patients who have used high dosages forlong periods. Osteoporosis, which affects both men andwomen with COPD, may be considered one of the systemicmanifestations of COPD;4. The high prevalence ofosteoporosis in patients with COPD indicates an increasedrisk of vertebral and hip fractures in this group.
Prevention. Prevention of osteopenia and osteoporosisis far preferable to treatment, despite the availability ofnew pharmacologic therapies. Key steps in the reductionof significant morbidity from osteoporosis are awarenessof the heightened risk of osteoporosis in patients withCOPD and implementation of strategies to prevent boneloss. Other measures are listed in the Table.
Order a baseline dual-energy x-ray absorptiometricscan for patients who use corticosteroids in any form.This will serve as a useful comparison for later BMD studiesif osteopenia or osteoporosis is suspected.
I recommend that postmenopausal women with osteopeniatake low-dose estrogen replacement therapy. Useof testosterone and human growth factor is controversial.Vitamin D, 400 to 800 IU/d, and calcium, 1000 to 1500mg/d, are recommended for prevention.
Regular exercise that focuses on increased strengthand balance may mitigate osteopenia and prevent falls.Maintaining a body mass index above 22 may prevent orforestall osteopenia.5

References:

REFERENCES:


1.

Iqbal F, Michaelson J, Thaler L, et al. Declining bone mass in men with chronicpulmonary disease: contribution of glucocorticoid treatment, body mass index,and gonadal function.

Chest.

1999;116:1616-1624.

2.

Incalzi RA, Caradonna P, Ranieri P, et al. Correlates of osteoporosis in chronicobstructive pulmonary disease.

Respir Med.

2000;94:1079-1084.

3.

Wise R, Connett J, Weinmann G, et al. Effect of inhaled triamcinolone on thedecline in pulmonary function in chronic obstructive pulmonary disease.

N EnglJ Med.

2000;343:1902-1909.

4.

Schols AM, Mostert R, Soeters PB, Wouters EF. Body composition and exerciseperformance in patients with chronic obstructive pulmonary disease.

Thorax.

1991;46:695-699.

5.

Foley RF, ZuWallack R. The impact of nutritional depletion in chronic obstructivepulmonary disease.

J Cardiopulmon Rehabil.

2001;21:288-295.

6.

Biskobing DM. How great is the risk of osteoporosis in patients with COPD?

J Respir Dis.

2002;23:406-409.