BONE DISEASES WITH COPD
Dr. Sudhir Chaudhri
Osteoporosis or bone weakness is a common finding in COPD. It is characterized by low bone mass accompanied by micro architectural changes in bone that increase the susceptibility to fracture. Osteoporosis is measured by a test called Bone Mineral Density (BMD). Osteopenia is stage of bone weakness before the development of osteoporosis. As many as 35 to 72% of patients with COPD have been reported to be suffering with osteopenia, and 36 to 60% of patients with COPD patients have osteoporosis. As the severity of COPD progresses, the proportion of patients with osteoporosis increase.
Numerous risk factors that contribute to the development of osteoporosis in COPD patients include tobacco smoking, vitamin D deficiency, low body mass index (BMI), hypogonadism (low gonadal hormone production such as estrogen in women and testosterone in men), corticosteroids therapy, decreased mobility and muscle weakness. Tobacco Smoking is not only the major causative factor of COPD but also decreases calcium absorption from intestines. Vitamin D deficiency leads to decreased mineralization of bone.
Multiple fractures may occur. Back-bone fractures are common especially in chest region in comparison with waist. Hip fractures are the most serious consequence of osteoporosis. Rib fractures can also occur.
COPD patients should be screened every 12-24 months with measurements of BMD by DEXA machine. A physical therapy program to increase exercise endurance, muscle strength, balance and prevention of fall improves quality of life, functional status and prevents fractures. Calcium and vitamin D supplementation have been shown to be beneficial if taken under physicians’ guidance. Your doctor may investigate you for hormone therapy. Bisphosphonate class of medicines are also considered by doctors to prevent bone loss.
Professor and Head
Department of Respiratory Diseases,
GSVM Medical College, Kanpur