This time last year we told you about the various osteoporosis risk factors such as smoking, calcium deficiencies and other factors in our Learning About Osteoporosis Risk Factors We Can Control blog post. We also highlighted the risks associated with the long-term use of medications like prednisone, cortisone, prednisone, and dexamethasone and how they may weaken and damage bone tissue.
Many patients with Chronic Obstructive Pulmonary Disease (COPD) rely on steroids like steroid medications especially those with advanced disease. Combined with a history of smoking and other factors, doing so accelerates these risks. A significant proportion of patients also report that, in addition to their pulmonary disease, they have other conditions that may limit their ability to exercise. One of the most frequent concerns is “thin bones,” or osteoporosis. It is estimated that between one in ten or even one in five patients with COPD are affected by osteoporosis.
Osteoporosis is a disease in which the mineral density of the bones is inappropriately low, compared with what is expected as a result of the normal aging process. The consequence of low bone density includes an increased risk of fractures. In the general population, osteoporosis is more prevalent in postmenopausal women and between men older than 75 years, probably due to age-related changes in sex hormones. Additional risk factors include lack of exercise, being underweight, poor nutritional status, alcohol, and tobacco use. The use of systemic steroids is another risk factor. Unfortunately, many of these risk factors are shared by patients with COPD: advanced age, tobacco use, lack of exercise, low weight, and systemic steroid use. Therefore, it is not surprising that osteoporosis is so common in patients with COPD.
However, some investigators believe that the inflammation associated with the disease of COPD itself may contribute to bone loss. Similar inflammatory cells and chemical mediators of inflammation in the blood stream could be responsible for both destruction of the lungs and the bone, but more research will be needed before arriving at a definitive conclusion. In support of a possible relationship between COPD and osteoporosis, researchers have shown that the frequency of osteoporosis and its precursor “osteopenia”(low-normal bone density) increases in parallel with decreased lung function and increasing emphysema. Additionally, for years a persistent concern has been the potential for COPD medications, including inhaled corticosteroids, to increase the risk for osteoporosis, although there is currently no definitive evidence that they have a negative effect on bone health in COPD.
In any given individual, osteoporosis is a risk factor for fractures. In COPD patients this can be particularly problematic. Spine fractures and rib fractures may impair an already limited respiratory capacity and make maintaining an effective cough effort more difficult. Hip fractures may also lead to immobility and trigger a downward spiral of decreased exercise capacity and breathlessness.
The most important measures COPD patients can take to improve their bone health include quitting smoking, exercise such as that provided in a supervised pulmonary rehabilitation program, maintaining a healthy weight and ensuring adequate intake of calcium and vitamin D.
Because of the increased risk for osteoporosis, many experts believe that people with COPD, male or female, should undergo regular evaluations for bone density and discuss the results with their healthcare provider. Patients can do this at the Bone Health Clinic at Orthopaedic Associates of Michigan. We provide comprehensive orthopedic bone health care, including diagnosis, treatment, therapy, education, and research. The Clinic provides patient and family risk assessments, dietary information, coordinates lab and pharmacy services, and offers specialized physical and occupational therapy—all with the goal and focus of promoting bone health, reducing fracture risks, accelerating healing, and preventing re-fractures.
Contact us today for an appointment at 616-459-7107.
Sources: OAM Physicians, Mayo Clinic, WebMD, National Osteoporosis Foundation, National Heart Lung and Blood Institute