Chest
Volume 121, Issue 2, February 2002, Pages 609-620
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COPD and Osteoporosis

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Osteoporosis, with resulting fractures, is a significant problem in patients with advanced COPD. The etiology for the bone loss is diverse but includes smoking, vitamin D deficiency, low body mass index, hypogonadism, sedentary lifestyle, and use of glucocorticoids. Effective strategies to prevent bone loss and/or to treat osteoporosis include calcium and vitamin D, hormone replacement when indicated, calcitonin, and bisphosphonate administration. However, many patients remain undiagnosed until their first fracture because of the lack of recognition of the disease. With an increased awareness by pulmonologists and the increased use of preventive strategies, the impact of osteoporosis on those patients with COPD should decrease.

Section snippets

Low Bone Mineral Density

Osteoporosis is characterized by low bone mass accompanied by microarchitectural changes in bone that increase the susceptibility to fracture.910 The World Health Organization definition for osteoporosis is based on the measurement of bone mineral density (BMD).11 Osteopenia is defined as a BMD between 1 and 2.5 SDs below the mean for young adults (ie, the T score), while osteoporosis is defined as a BMD of > 2.5 SDs below the mean for young adults.11 This definition was developed for white

Pathophysiology of Osteoporosis in COPD

There are numerous risk factors that contribute to the pathophysiology of osteoporosis seen in COPD patients. These risk factors include smoking, vitamin D deficiency, low body mass index (BMI), hypogonadism, and decreased mobility as the disease progresses (Table 2). In addition to these risk factors, glucocorticoid use in many patients with COPD is thought to be a contributing factor in the development of osteoporosis. However, since osteoporosis has been reported in COPD patients who have no

Prevention and Treatment

The prevention of osteoporosis in COPD patients is dependent on an awareness of the magnitude of the problem. There is little impetus for screening and/or preventive therapy because patients are generally asymptomatic until they experience a fracture. However, early recognition and the institution of preventive therapy are essential in avoiding fractures. Patients who are being started on long-term inhaled or oral glucocorticoid therapy should be considered for preventive therapy since

Recommendations and Summary

Preventive strategies to decrease osteoporotic fractures in those patients with COPD should begin with screening for the disease. All patients receiving long-term oral glucocorticoid therapy (> 7.5 mg prednisone/d) should have BMD testing. Ideally, BMD should be measured prior to initiating therapy, especially in those patients at highest risk such as postmenopausal women. BMD measurement also should be considered in COPD patients at high risk for osteoporosis such as those receiving high-dose

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