Correlates of osteoporosis in chronic obstructive pulmonary disease: An underestimated systemic component.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) patients are at increased risk of osteoporosis. Osteoporosis is under diagnosed and under treated in these patients and the underlying mechanisms remain unclear. To date, screening recommendations for osteoporosis in COPD patients are not available.


OBJECTIVE
To examine the prevalence of drug treatment of bone abnormalities as well as the clinical determinants of osteoporosis in COPD.


METHODS
COPD patients (n=554) consecutively entering pulmonary rehabilitation were included in this cross-sectional study. Medical history, current medication use, smoking status, lung function, bone mineral density, body composition and other clinical characteristics were assessed before entering pulmonary rehabilitation. Univariate- and multivariate multinomial logistic regression analyses were used to determine correlates of osteoporosis.


RESULTS
Twenty-one percent of patients had osteoporosis and 41% had osteopenia. Osteoporosis was pharmacologically under treated (82% of osteoporotic patients were not receiving bone medication). Independent predictors of osteoporosis were cachexia (OR: 12.1; 95%CI: 4.5-32.7; p<0.001), age between 55 and 65 years (OR: 6.0; 95%CI: 2.2-16.3; p<0.001) and over 65 years (OR: 11.7; 95%CI: 4.1-33.1; p=<0.001). Overweight (OR: 0.1; 95%CI: 0.05-0.4; p=0.001) and obesity (OR: 0.78; 95%CI: 0.02-0.4; p=0.002) showed a substantial protective effect.


CONCLUSIONS
The majority of COPD patients with osteoporosis entering pulmonary rehabilitation did not receive pharmacological treatment for osteoporosis. Cachectic COPD patients should be screened for osteoporosis, especially when over 55 years of age.
Graat-Verboom
Lidwien
L
Department of Respiratory Medicine, University Medical Centre Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. lidwiengraat@versatel.nl
Spruit
Martijn A
MA
van den Borne
Ben E E M
BE
Smeenk
Frank W J M
FW
Martens
Elisabeth J
EJ
Lunde
Ragnar
R
Wouters
Emiel F M
EF
D000368:Aged; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012044:Regression Analysis; D012307:Risk Factors
D050071:Bone Density Conservation Agents