COPD as an independent risk factor for osteoporosis and fractures.

Autor: Adas-Okuma MG; Discipline of Endocrinology, Escola Paulista de Medicina (UNIFESP) Universidade Federal de São Pulo, Federal University of São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, Brazil. dramariana.adas@gmail.com., Maeda SS; Discipline of Endocrinology, Escola Paulista de Medicina (UNIFESP) Universidade Federal de São Pulo, Federal University of São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, Brazil., Gazzotti MR; Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil., Roco CM; Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil., Pradella CO; Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil., Nascimento OA; Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil., Porto EF; Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil., Vieira JGH; Discipline of Endocrinology, Escola Paulista de Medicina (UNIFESP) Universidade Federal de São Pulo, Federal University of São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, Brazil., Jardim JR; Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil., Lazaretti-Castro M; Discipline of Endocrinology, Escola Paulista de Medicina (UNIFESP) Universidade Federal de São Pulo, Federal University of São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2020 Apr; Vol. 31 (4), pp. 687-697. Date of Electronic Publication: 2019 Dec 06.
DOI: 10.1007/s00198-019-05235-9
Abstrakt: Fractures are common in individuals with COPD and occur at higher bone mass values than expected. COPD appears to be an important risk factor for bone fragility.
Introduction: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of osteoporosis and fractures, but screening and prophylactic measures to prevent both disorders are often neglected in this population. This case-control study assessed the prevalence of osteopenia, osteoporosis, and fractures in patients with COPD, and identified potential risk factors for fractures in this population.
Methods: Overall, 91 patients with COPD (COPD group; COPDG) and 81 age- and sex-matched controls (control group; CG) were assessed with bone mineral density (BMD), thoracic/lumbar spine radiographs, and serum PTH and 25-hydroxyvitamin D (25[OH]D) levels. The occurrence of prior fractures was retrieved from clinical history.
Results: The prevalence of total fractures in the COPDG was 57.1% (odds of fracture 4.7 times greater compared with the CG), and the femoral neck T-score emerged as the best predictor of fractures. Compared with the CG, the COPDG had lower spine and femoral BMD (p ≤ 0.01) and 25(OH)D levels (p = 0.01) and 2.6 times greater odds of osteoporosis. Among men, vertebral fractures were more prevalent in the COPDG versus CG (25.9% vs. 6.5%, respectively, p = 0.01). The odds of fracture increased with femoral neck T-scores ≤ - 2.7 in the CG and ≤ - 0.6 in the COPDG.
Conclusion: These results add robust evidence to an increased odds of osteoporosis and fractures in COPD. Fractures in the COPDG occurred at higher BMD values than expected, suggesting that COPD may be an independent marker of fracture risk, reinforcing a need for regular osteoporosis screening with BMD measurement and prophylaxis of fractures in patients with this disorder.
Databáze: MEDLINE
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