The prevalence of osteopenia and osteoporosis in patients with chronic obstructive pulmonary disease and their relation with disease severity

Fatma Yıldırım; Esra Meltem Koç; Tuğba Körlü Akkale; Sakine Nazik Bahçecioğlu; Nurdan Köktürk

doi:10.7197/223.vi.536515

EN TR

The prevalence of osteopenia and osteoporosis in patients with chronic obstructive pulmonary disease and their relation with disease severity

Abstract

Objective: Osteopenia and osteoporosis are within the systemic features of chronic obstructive pulmonary disease (COPD). The present study aimed to investigate the frequency of osteopenia and osteoporosis in COPD patients and to determine the correlation between bone mineral dansity (BMD) and the clinical characteristics of COPD patients.

Method: This retrospective study was conducted in the department of Pulmonary Medicine, at a university hospital in Turkey between January 2014 to August 2016. Data of 92 patients with COPD who underwent dual energy X-ray absorptiometry to evaluate BMD were extracted from the medical records. Osteopenia/osteoporosis was assessed with the T and Z scores.

Results: Mean age of the patients was 66.2±9.2 years and males comprised 89.1% of the study group. The frequency of osteopenia/osteoporosis in the COPD patients was 63.0%. Osteopenia/osteoporosis frequency was same in GOLD C/D and GOLD A/B patients [12/19 (%63.1) and 46/73 (%63.1)]. Exacerbation number in the previous year and the readmission rates were higher and the duration of hospital stay of the patients with osteoporosis was longer (p<0.05). A significant positive correlation was noted between body mass index and BMD (r=0.489, p<0.001), BMD and FEV1/FVC (r=0.226, p=0.040), exacerbation number in the previous year (r=-0.429, p=0.001) and the duration of hospital stay in admission (r=-0.228, p=0.034). As the severity of GOLD stage increased, the prevalence of osteopenia was also increased (p_trend <0.001).

Conclusions: Our data suggest that the prevalence of osteopenia and osteoporosis in COPD patients is high independent of disease stage. Abnormal BMD results are associated with frequent exacerbation, prolongation of hospital stay, and poor course of the disease.

Keywords

Chronic obstructive pulmonary disease,osteopenia,bone mineral density,osteoporosis,forced expiratory volume in 1 second (FEV1)/ forced vital capacity (FVC)

Kronik obstrüktif akciğer hastalığı olan hastalarda osteopeni ve osteoporoz sıklığı ve hastalık şiddeti ile ilişkisi

Öz

Amaç: Osteopeni ve osteoporoz, kronik obstrüktif akciğer hastalığının (KOAH) sistemik özellikleri içindedir. Bu çalışmada KOAH hastalarında osteopeni ve osteoporoz sıklığını araştırmak ve KOAH hastalarının kemik mineral dansitesi (KMD) ile klinik özellikleri arasındaki ilişkiyi belirlemek amaçlanmıştır.

Yöntem: Bu retrospektif çalışma Türkiye'deki bir üniversite hastanesinde Göğüs Hastalıkları bölümünde Ocak 2014 - Ağustos 2016 tarihleri arasında yapıldı. KMD'yi değerlendirmek için çift enerjili X-ışını absorpsiyometrisi yapılan KOAH'lı 92 hastanın verileri tıbbi kayıtlardan elde edildi. Osteopeni/osteoporoz T ve Z skorları ile değerlendirildi.

Bulgular: Hastaların ortalama yaşı 66.2±9.2 idi ve erkekler çalışma grubunun %89.1'ini oluşturuyordu. KOAH hastalarında osteopeni/osteoporoz sıklığı %63.0 idi. Osteopeni/osteoporoz sıklığı GOLD evre C/D ve GOLD evre A/B hastalarda aynıydı [12/19 (%63.1) ve 46/73 (%63.1)]. Osteoporozu olan hastaların bir önceki yıl alevlenme sayıları ve yeniden basvuru oranları daha yüksek; hastanede kalış süreleri daha uzundu (p<0.05). Vücut kitle indeksi ile KMD (r=0.489, p<0.001), KMD ile FEV1/FVC (r=0.226, p=0.040), KMD ile önceki yıl alevlenme sayısı (r=-0.429, p=0.001) ve KMD ile hastanede yatış süresi (r=-0.228, p=0.034) arasında anlamlı bir korelasyon tespit edildi. GOLD evresinin şiddeti arttıkça, osteopeni prevalansı da artmıştı (p_trend <0.001).GOLD evresinin şiddeti arttıkça, osteopeni prevalansı da artmıştır (Ptrend <0.001).

Sonuç: Verilerimiz KOAH hastalarında evreden bağımsız olarak osteopeni ve osteoporoz sıklığının yüksek olduğunu ortaya koymaktadır. Anormal KMD sonuçları sık alevlenme, hastanede kalış süresinde uzama gibi hastalığın kötü seyri ile ilişkilidir.

Anahtar Kelimeler

Kronik obstrüktif akciğer hastalığı; osteopeni; kemik mineral dansitesi,osteoporoz; 1 saniyede zorunlu ekspirasyon hacmi (FEV1) / zorunlu vital kapasite (FVC)

Kaynakça

1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2014. Available from: http://goldcopd.org.
2. Dursunoğlu N, Köktürk N, Baha A, Bilge AK, Börekçi Ş, Çiftçi F et al. Turkish Thoracic Society COPD Comorbidity Group. Comorbities and their impact on chronic obstructive pulmonary disease. Tuberk Toraks 2016;64:292-301.
3. Bolton CE, Ionescu AA, Shiels KM, Pettit RJ, Edwards PH, Stone MD et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004;170:1286–93.
4. Bhattacharyya P, Paul R, Ghosh M, Dey R, Dey R, Barooah N et al. Prevalence of osteoporosis and osteopenia in advanced chronic obstructive pulmonary disease patients. Lung India 2011;28:184–86.
5. Watanabe R, Inoue D. Secondary osteoporosis. Chronic obstructive pulmonary disease:COPD. Clin Calcium 2018;28(12):1647-1652.
6. Graat-Verboom L, Wouters EF, Smeenk FW, van den Borne BE, Lunde R, Spruit MA. Current status of research on osteoporosis in COPD: a systematic review. Eur Respir J 2009;34:209–18.
7. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function. In: Series ‘‘ATS/ERS Task Force: Standardisation of lung function testing”. Eur Respir J 2005;26:153-61.
8. Kanis JA. WHO Study Group Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int 1994;4(6):368–81.

9. International Society for Clinical Densitometry (ISCD) Official Positions– Adult. Available from: http://www.iscd.org/official-positions/2013-iscd-official-positions-adult; 2013.
10. Jorgensen NR, Schwarz P, Holme I, Henriksen BM, Petersen LJ, Backer V. The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study. Respir Med 2007;101:177–85.
11. Silva DR, Coelho AC, Dumke A, Valentini JD, de Nunes JN, Stefani CL et al. Osteoporosis prevalence and associated factors in patients with COPD: a cross-sectional study. Respir Care2011;56:961-8.
12. Soriano JB, Visick GT, Muellerova H, Payvandi N, Hansell AL. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest 2005;128:2099–107.
13. Ferguson GT, Calverley PMA, Anderson JA, Jenkins CR, Jones PW, Willits LR et al. Prevalence and progression of osteoporosis in patients with COPD: results from the TOwards a Revolution in COPD Health study. Chest 2009;136(6):1456-1465.
14. Graat-Verboom L, van den Borne BE, Smeenk FW, Spruit MA, Wouters EF. Osteoporosis in COPD outpatients based on bone mineral density and vertebral fractures. J Bone Miner Res 2011;26(3):561-8.
15. Vrieze A, de Greef MH, Wijkstra PJ, Wempe JB. Low bone mineral density in COPD patients related to worse lung function, low weight and decreased fat-free mass. Osteoporos Int 2007;18(9):1197-202.
16.İntepe YS, Yıldırım E, Metin B, Karaçavuş S, Balbaloğlu Ö, Korkmaz M. The Evaluation of Bone Mineral Density in Patients With Chronic Obstructive Pulmonary Disease. Bozok Tıp Derg 2016;1(1):20-6.
17. Karapolat H, Eyigör S, Gürgün A, Kirazlı Y, Başoğlu KÖ, Durmaz B. The Evaluation of Osteoporosis in Male Patients with COPD. Osteoporoz DünyasIndan 2007;13:70-4.
18. Graumam RQ, Pinheiro MM, Nery LE, Castro CHM. Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity. Osteoporos Int 2018;29(6):1457-1468.
19. Lee SH, Kwon HY. Prevalence of Osteoporosis in Korean Patients with Chronic Obstructive Pulmonary Diseaseand Their Health-related Quality of Life According to the Korea National Health and Nutrition Examination Survey 2008-2011. J Bone Metab 2017;24(4):241-248.

Ayrıntılar

Birincil Dil

İngilizce

Konular

Sağlık Kurumları Yönetimi

Bölüm

Araştırma Makalesi

Yazarlar

Fatma Yıldırım ^*
Türkiye

Esra Meltem Koç
Türkiye

Tuğba Körlü Akkale
Türkiye

Sakine Nazik Bahçecioğlu
Türkiye

Nurdan Köktürk

Yayımlanma Tarihi

28 Mart 2019

Gönderilme Tarihi

6 Mart 2019

Kabul Tarihi

12 Mart 2019

Yayımlandığı Sayı

Yıl 2019 Cilt: 41 Sayı: 1

DOI

https://doi.org/10.7197/223.vi.536515

IZ

https://izlik.org/JA83PE45HP

Kaynak Göster

RIS / Bibtex

AMA

1.Yıldırım F, Koç EM, Körlü Akkale T, Nazik Bahçecioğlu S, Köktürk N. The prevalence of osteopenia and osteoporosis in patients with chronic obstructive pulmonary disease and their relation with disease severity. CMJ. 2019;41(1):51-58. doi:10.7197/223.vi.536515