慢性阻塞性肺疾病继发骨质疏松症患者血清高密度脂蛋白胆固醇水平的变化

COPD不仅累及肺脏,还可引起全身(或称肺外)的不良效应,骨质疏松症是其全身不良效应表现之一.目前的研究结果证实,COPD患者的骨质疏松症患病率明显高于同龄人,且口服糖皮质激素、活动减少、吸烟、营养不良、维生素D缺乏、高龄和缺氧等均可能是COPD患者合并骨质疏松症的危险因素[1].     

老年慢性阻塞性肺疾病与继发性骨质疏松症的关系探讨

目的 观察老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者骨密度(BMD)、肺功能和血气分析的变化,探讨老年COPD与继发性骨质疏松症的关系.方法 用双能X线吸收测定仪测定32例老年男性COPD患者腰椎(L_(1-4))、股骨近端[颈部(Neck)、大粗隆(Troch)、合计(Total)]BMD,同时用肺功能仪测定肺功能,血气分析仪测量动脉血气分析,以及生化、血钙等检查.结果 COPD组的BMD值与对照组相比显著降低(P<0.001),COPD患者BMD与第1秒用力呼气容积占预计百分比呈显著正相关(P<0.001).结论 老年COPD组BMD低于对照组.COPD是继发性骨质疏松症的患病因素之一.老年COPD患者BMD检查能及早发现骨质疏松.低氧血症可能是老年COPD患者合并骨质疏松症的主要危险因素.     

慢性阻塞性肺疾病合并骨质疏松症的研究进展

慢性阻塞性肺疾病(COPD)是临床上常见的一种可防治疾病,发病率、致残率、致死率均较高,而骨质疏松症是COPD常见的一种肺外并发症,目前多数临床医务人员及患者仍未对骨质疏松症足够重视,部分患者甚至发生了骨折也未认识到自身骨量减少、未进行有效干预,这也是慢阻肺患者骨质疏松症发生率升高的原因.本文就COPD与骨质疏松症的关...     

重视慢性阻塞性肺疾病相关的骨质疏松症：病例和文献复习

目的重视和提高慢性阻塞性肺疾病（COPD）相关的骨质疏松症早期诊断及防治意识。方法报道2例COPD相关的骨质疏松症并文献复习。结果2例COPD患者均已出现明显骨质疏松症表现,但因医务人员相关意识不足而多次误诊。结合病例复习文献,肺功能损害程度与骨质疏松症的发生以及疾病的严重程度呈正比,COPD患者合并股骨颈部和椎体的骨质疏松症是对照组的5倍。COPD往往有肺通气障碍,如伴有呼吸性酸中毒时可加速骨组织中的钙释放到循环血液中,此外COPD和骨质疏松症具有相同患病因素,如吸烟、糖皮质激素的应用、低体质量、营养不良、活动减少等,使COPD患者骨质疏松症的发病年龄明显提前。结论对COPD合并骨质疏松症早期诊断和干预,对于其活动能力的保持和生活质量的提高,乃至延缓死亡等具有重要意义。     

慢性阻塞性肺病和骨质疏松

慢性阻塞性肺病(COPD)不仅是肺部疾病,而且是一种全身性疾病.骨质疏松是COPD患者的肺外表现之一.随着COPD患者病情加重,骨质疏松的发病率亦有所增加.但COPD患者发生骨质疏松的机制至今尚未完全明确.探讨COPD患者骨质疏松症的发生情况及影响因素,有助于提高对COPD发生骨质疏松的早期认识,预防骨质疏松的发生、发展,对改进COPD患者的生活质量和延长生命具有重要意义.     

慢性阻塞性肺疾病与骨质疏松症相关性研究现状

慢性阻塞性肺疾病（COPD）具有高患病率、高致残率、高病死率的特点,主要累及肺脏,但也可引起全身不良反应,其中骨质疏松症是常见的肺外表现之一。近年来COPD合并骨质疏松症患病率明显增加,并成为COPD患者致残、致死的重要因素之一。为了更好地探讨COPD和骨质疏松症的关系,本文将着重介绍COPD与骨质疏松症相关性方面的新进展,以期对其诱因和预防、治疗有一个全面的认识。     

慢性阻塞性肺疾病合并骨质疏松症的研究进展

慢性阻塞性肺疾病(COPD)目前仍是全球患病率、致残率、病死率高的慢性呼吸系统疾病, 常可合并多种合并症。骨质疏松症是其中之一, 是一种以低骨量和骨组织微观结构退化为特征的系统性疾病, 常导致骨强度下降, 骨折的风险随之增加, 但在临床中常被忽视。因此, 了解COPD合并骨质疏松症的危险因素、伴随疾病、诊断与治疗, 对于COPD患者具有重要意义。     

慢性阻塞性肺病患者骨代谢变化及临床意义

为探讨慢性阻塞性肺疾病（COPD）患者骨代谢的变化，对27例男性COPD患者（COPD组）应用双能X线吸收测定仪（DEXA）测定其腰椎（L2－L4）、股骨颈（Neck)、股骨三角（Ward‘s)和股骨大转子（Troch)骨密度（BMD），同时检测血清总蛋白（TP）、白蛋白（A）、钙（Ca)、磷（P），尿Ca/Cr、尿P／Cr、碱性磷酸酶（AKP），血清骨钙素（BGP），尿羟脯氨酸（HOP）、动脉血气，并设对照组比较。结果COPD伴呼吸衰竭患者的BMD较无呼吸衰竭者低；BMD与动脉血PaO2呈正相关（P＜0．05）。COPD组与对照组骨质疏松发生例数比较，病因学机会比（OR）＞3，病因学分数（EF）＞40％。认为COPD可能是骨质疏松症（OP）的危险因素；COPD继发OP可能与其缺氧、营养不良及骨矿代谢紊乱有关。     

人血清胎球蛋白A在COPD中的作用

COPD是一种慢性炎症性疾病,这种持续低水平的系统性炎症可能与其并发症,如心血管疾病、代谢综合征、骨质疏松等有密切关系.人血清胎球蛋白A具有抗炎及抑制血管钙化的生物学作用,可能与COPD的炎症反应及其合并症有关,认识人血清胎球蛋白A在COPD中的作用,可能为COPD患者的诊断和治疗提供新的思路.     

女性慢性阻塞性肺疾病研究进展

女性慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者人数呈逐年上升趋势.女性COPD患者临床表现及其对于治疗反应存在的性别差异可能与病理生理学、免疫反应和激素水平等方面相关.本文就女性COPD发病基础及临床表现特点的最新研究进展作一综述.     

A comparison of bone mineral density in elderly female patients with COPD and bronchial asthma

BACKGROUND: A recent study has shown that osteoporosis and vertebral fractures are quite common in patients with advanced COPD and showed a significant relationship to the mortality of these patients. These results suggested that management of osteoporosis in advanced COPD is an important intervention. But whether patients with COPD who had never received chronic systemic corticosteroids have a high incidence of osteoporosis and whether these patients require treatment strategies to decrease osteoporotic fracture is not yet known. Furthermore, it is unclear whether there are differences in terms of the degree of osteoporosis between patients with COPD and patients with bronchial asthma. OBJECTIVES: To compare the degree of osteoporosis and bone metabolism markers between elderly women with COPD and those with bronchial asthma who had never received chronic systemic corticosteroids, and to determine the factors influencing bone metabolism in these patients. DESIGN: Cross-sectional medical survey. PATIENTS: A total of 44 elderly female patients with COPD (n = 20) or bronchial asthma (n = 24) who had not received chronic systemic corticosteroids were enrolled (mean +/- SEM age, 74.6 +/- 1.0 years). MEASUREMENTS: Total body and lumbar bone mineral density (BMD) were measured by dual-energy x-ray absorptiometry, and the data were compared between the two groups. In addition, the association between bone mass and clinical variables was determined. RESULTS: When lumbar BMD was expressed as a Z score, the Z scores of patients with COPD were significantly lower than those of patients with bronchial asthma (p < 0.01). The prevalence of osteoporosis was also significantly higher in patients with COPD (50% vs 21%, p < 0.05). In patients with COPD, body mass index was positively correlated with BMD in the lumbar spine (r = 0.55, p = 0.02) and total body (r = 0.49, p = 0.03). Other clinical, biochemical, and anthropometric variables were not correlated with BMD. CONCLUSIONS: In elderly female patients, osteoporosis is more common in cases of COPD than in bronchial asthma, even if these patients had not received long-term systemic corticosteroids. The explanation for the higher prevalence of osteoporosis in COPD is still not known, but preventive strategies to decrease osteoporotic fractures should be added to the management of elderly patients with COPD.     

Osteoporosis in chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of osteoporosis because of their age, limited physical activity, low body mass index, smoking, hypogonadism, malnutrition, and use of corticosteroids. Systemic inflammation represents an additional pathomechanism contributing to the development of osteoporosis in COPD patients. Males in their mid to late 60s with a smoking history of greater than 60 pack-years have a prevalence rate of vertebral fractures similar to, and possibly greater than, postmenopausal women greater than or equal to 65 years old: in patients with severe COPD, up to 50-70% have osteoporosis or osteopenia, and up to 24-30% have compression vertebral fractures. Correlates of osteoporosis in COPD are mainly measures of body composition, disease severity and the use of corticosteroids, although causality has not been proven. Systemic corticosteroids remain the most common cause of drug-related osteoporosis, and a meta-analysis concluded that the use of more than 6.25 mg prednisone daily led to decreased bone mineral density (BMD) and increased fracture risk. In contrast, the effects of the long-term use of inhaled corticosteroids on BMD remain debatable. Effects of treatment of osteoporosis have not been investigated in samples consisting of COPD patients only but the recommendations follow the general recommendations for the diagnosis and treatment of osteoporosis. Early recognition of BMD loss is essential, and assumes close interdisciplinary cooperation between respirologists and reumatologists. Longitudinal follow-up to assess determinants of osteoporosis in COPD and randomised placebo-controlled trials on the effects of treatment of osteoporosis in patients with COPD only are warranted. In the future, novel therapeutical strategies such as monoclonal antibodies against osteoclasts activators may prove their beneficial effects in the treatment of COPD-related osteoporosis.     

Comorbidities of COPD

Chronic obstructive pulmonary disease (COPD) is often associated with comorbidities. Cardiovascular diseases, weight loss, loss of fat free mass combined with muscle dysfunction, osteoporosis and depression are the main comorbidities in COPD. Cardiovascular comorbidities, weight loss and loss of fat free mass are predictors of mortality of patients with COPD. Thus, the extrapulmonary manifestations are meaningful parameters of clinical assessment. Systemic inflammation is probably the key to the extrapulmonary signs of COPD.     

Komorbiditäten bei COPD

Chronic obstructive pulmonary disease (COPD) is often associated with comorbidities. Cardiovascular diseases, weight loss, loss of fat free mass combined with muscle dysfunction, osteoporosis and depression are the main comorbidities in COPD. Cardiovascular comorbidities, weight loss and loss of fat free mass are predictors of mortality of patients with COPD. Thus, the extrapulmonary manifestations are meaningful parameters of clinical assessment. Systemic inflammation is probably the key to the extrapulmonary signs of COPD.     

Enfermedad pulmonar obstructiva crónica y osteoporosis

Osteoporosis is one of the systemic effects associated with chronic obstructive pulmonary disease (COPD). Risk factors for bone loss include smoking, skeletal muscle weakness, low bone mass index (BMI), vitamin D deficiency, glucocorticoid use, hypogonadism and systemic inflammation. The most important clinical feature is vertebral fracture, due to its significant morbidity and mortality. The treatment of osteoporosis includes calcium and vitamin D, bisphosphonates, anabolic agents and pulmonary rehabilitation. Prospective studies are required to determine the prevalence of osteoporosis in COPD and to identify which patients are at high risk for osteoporotic fracture. The development of new drugs to control systemic inflammation may contribute to specific treatments for osteoporosis in COPD.     

COPD and osteoporosis

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.     

What community measurements can be used to predict bone disease in patients with COPD?

BACKGROUND: Osteoporosis is common in patients with COPD. Previously we have reported that loss of fat-free mass (FFM), measured by dual X-ray absorptiometry (DXA) is associated with loss of bone mineral density (BMD). In addition, in patients with a low body mass index (BMI) and a low FFM, all had evidence of bone thinning, 50% having osteopenia and 50% osteoporosis. We explored the utility of different anthropometric measures in detecting osteoporosis in a community-based COPD population. METHODS: Patients with confirmed COPD and not on long-term oral corticosteroids (n=58) performed spirometry. They underwent nutritional assessment by skinfold anthropometry, midarm circumference, calculation of both % ideal body weight (IBW) and BMI. All had DXA assessment of BMD. RESULTS: A total of 58 COPD patients had anthropometric measurements taken, with a mean age of 66.8 (SD 8.7) years, 31 (58%) were male, with a forced expiratory volume in 1s (FEV(1)) of 54.17 (20.18)% predicted. Osteoporosis was present at either the hip or lumbar region in 14 patients (24%). The useful anthropometric measurements identifying those with osteoporosis were both % IBW and BMI. The adjusted odds ratio for %IBW was 0.93 (95% confidence interval (CI) 0.87, 0.99), p=0.016 and for BMI: 0.79 (0.64-0.98), p=0.03. The receiver operating characteristics (ROC) score for both was 0.88, indicating a good fit. CONCLUSION: Osteoporosis is common, even in patients with mild airways obstruction. Nutritional assessment, incorporating a calculation of their BMI or %IBW may confer an additional benefit in detecting those at risk of osteoporosis and guide referral for BMD measurement.     

Letter to the Editor Response

Abstract

Background: COPD pathology involves not only the lungs but also extrapulmonary abnormalities. Osteoporosis is one of the most important abnormalities because it may cause vertebral compression fractures and deteriorate pulmonary function. COPD patients have many risk factors for osteoporosis, such as low BMI, decreased activity, systemic inflammation, and use of corticosteroids. Some of these factors have been shown to deteriorate with COPD exacerbations. We previously demonstrated the correlation between emphysema and osteoporosis and between emphysema progression and COPD exacerbations. Thus, the hypothesis that exacerbation causes osteoporosis progression in COPD patients was investigated. Methods: Forty-two COPD patients not on osteoporosis treatment for over 2 years were recruited. During follow-up, exacerbations had been prospectively recorded. Thoracic vertebral bone mineral density (BMD) was measured using chest CT, and the annual change in BMD was calculated. The change was compared between patients with and without a history of exacerbations. Results: The decrease in thoracic vertebral BMD was greater in patients with than in those without a history of exacerbations (median ΔBMD mg/ml?year: –3.78 versus –0.30, p = 0.02). Moreover, multivariate regression analysis showed that exacerbations and baseline PaO2 were independent predictors of the BMD decrease (R2 = 0.20, p = 0.007, and R2 = 0.09, p = 0.03, respectively) after adjustment for baseline age, smoking status, and airflow limitation. Conclusions: This is the first longitudinal study to demonstrate that COPD exacerbations are independently associated with osteoporosis progression. Osteoporosis progression should be evaluated in COPD patients, especially in those with a history of frequent exacerbations.