Correlates of osteoporosis in chronic obstructive pulmonary disease: An underestimated systemic component

Graat-Verboom, Lidwien; Spruit, Martijn A.; van den Borne, Ben E.E.M.; Smeenk, Frank W.J.M.; Martens, Elisabeth J.; Lunde, Ragnar; Wouters, Emiel F.M.; On behalf of the CIRO Network,

doi:10.1016/j.rmed.2009.02.014

« Previous Next »Respiratory Medicine
Volume 103, Issue 8 , Pages 1143-1151, August 2009

Correlates of osteoporosis in chronic obstructive pulmonary disease: An underestimated systemic component

Lidwien Graat-Verboom
- Department of Respiratory Medicine, University Medical Centre Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Department of Respiratory Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
- Corresponding author at: University Medical Centre Maastricht, Department of Respiratory Medicine, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. Tel.: +31 433875044; fax: +31 433875051.
Martijn A. Spruit
- Research, Development and Education, Centre for Integrated Rehabilitation of Organ failure (CIRO), Hornerheide 1, 6085 NM Horn, The Netherlands
Ben E.E.M. van den Borne
- Department of Respiratory Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
Frank W.J.M. Smeenk
- Department of Respiratory Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
Elisabeth J. Martens
- Department of Research and Education, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
- Centre of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
Ragnar Lunde
- Research, Development and Education, Centre for Integrated Rehabilitation of Organ failure (CIRO), Hornerheide 1, 6085 NM Horn, The Netherlands
- Department of Respiratory Medicine, St Jans Gasthuis, Vogelsbeek 5, 6001 BE Weert, The Netherlands
Emiel F.M. Wouters
- Department of Respiratory Medicine, University Medical Centre Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Research, Development and Education, Centre for Integrated Rehabilitation of Organ failure (CIRO), Hornerheide 1, 6085 NM Horn, The Netherlands
On behalf of the CIRO Network
- The CIRO network consists of:
  •Centre for Integrated Rehabilitation of Organ failure (CIRO), Horn, The Netherlands.
  
  •University Hospital Maastricht, Maastricht, The Netherlands.
  
  •St. Jans Gasthuis, Weert, The Netherlands.
  
  •Máxima Medisch Centrum, Veldhoven, The Netherlands.
  
  •St. Anna Hospital, Geldrop, The Netherlands.
  
  •Laurentius Hospital, Roermond, The Netherlands.

Received 2 December 2008; accepted 22 February 2009. published online 23 March 2009.

Summary

Rationale

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.

Objectives

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.

Main 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.

Keywords: Chronic obstructive pulmonary disease, Body composition, Bone densitometry, Osteopenia, Osteoporosis, Screening advice