Abstract and Introduction
Abstract
Purpose of Review: The purpose of this review is to examine the state of knowledge and clinical practice in the association of chronic obstructive pulmonary disease to osteoporosis and fracture incidence.
Recent Findings: There is a clear association between chronic obstructive pulmonary disease and excessive bone loss/risk of fractures. Little is known about the pathophysiological processes involved in the bone loss, but recent reports point to a continuous systemic inflammatory state in patients with chronic obstructive pulmonary disease. This inflammation involves the release of inflammatory cytokines such as tumour necrosis factor-α and interleukin-1. During the course of chronic obstructive pulmonary disease, a protein catabolic process takes place, including increased production of catalytic enzymes (matrix metalloproteinases etc.), which together with the inflammatory cytokines induces bone resorption.
Summary: Patients with chronic obstructive pulmonary disease are at increased risk of osteoporosis and fractures. Risk factors such as smoking, advanced age, physical inactivity, malnutrition, and low weight may be responsible, but a number of pathophysiological explanations including the presence of a chronic inflammatory state with increased levels of proinflammatory cytokines and protein catalytic enzymes may also be involved. The use of oral glucocorticoids is also a significant risk factor. Increased awareness is highly warranted to diagnose osteoporosis at an early stage, and professionals should be aware of the risk of osteoporosis in this patient population.
Introduction
Chronic obstructive pulmonary disease (COPD) is an increasing problem in both the Western and developing world. It causes significant morbidity and disability, and excess mortality is expected to become the third most common cause of death worldwide by 2020. It is a complex disease in which the initial symptoms are a cough as a result of excess mucus production, but several other symptoms may develop with disease progression. Patients with moderate to severe COPD often have multi-organ disease with severely impaired respiratory dysfunction, decreased physical activity, right ventricular heart failure, and decreased quality of life. As the disease progresses, however, osteoporosis becomes a more prevalent finding in the COPD patient population.