Men's Osteoporosis Support GroupCOPD and osteoporosis risk Respir Med. 2009 Mar 20. [Epub ahead of print]. Correlates of osteoporosis in chronic obstructive pulmonary disease: An underestimated systemic component. Graat-Verboom L and others. PMID: 19304474. This was a cross-sectional study involving 554 consecutive patients beginning therapy for chronic obstructive pulmonary disease, COPD. Such individuals are known to be at increased risk for osteoporosis, but the authors note there are currently no screening recommendations for osteoporosis in COPD individuals. The study was designed to detect clinical determinants of osteoporosis and the degree of drug treatment for osteoporosis. The important findings included, 21% and 41% had osteoporosis and osteopenia, respectively. 82% of the osteoporosis patients were not receiving any medications for it. Predictors of osteoporosis were cachexia and age greater than 55. Protection from osteoporosis occurred from being overweight or obese. The authors concluded: "The majority of COPD patients with osteoporosis entering pulmonary rehabilitation did not receive pharmacological treatment for osteoporosis. Cachectic COPD patients should be screened for osteoporosis, especially when over 55 years of age." Respir Med. 2007 Jan;101(1):177-85. Epub 2006 May 4. The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study. Jørgensen NR and others. PMID: 16677808. This is another cross-sectional study designed to find the incidence of osteoporosis in a group of 181 patients aged 50 to 70 years with severe COPD and to see how much responsibility could be due to glucocorticoid therapy. These individuals were said to have sufficient daily intake of calcium and vitamin D. Findings included 15 patients with previously undiagnosed spinal compression fractures, 22 patients with osteoporosis and 16 with osteopenia, for a total of 68% with low bone mineral density (BMD). This increased incidence of low BMD was not explained by previous glucocorticoid use. The authors concluded: "Thus, there is a significant need to screen patients with COPD to select the individuals in risk of fracture and to initiate prophylaxis or treatment for the disease." Editor's comments. The Wikipedia explanation of cachexia describes these people as being in metabolic acidosis. This means the bodily fluids are acidic in nature, an unnatural state for humans for more than 99% of their evolution, even if it is a mild condition brought on by a diet high in acid-forming foods. Am J Clin Nutr. 2002 Dec;76(6):1308-16. Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. Sebastian A and others. PMID: 12450898. This is available free on the publisher's Website. Thus the body tries to buffer this acidic state with basic calcium salts that are contained in the skeleton, mainly bicarbonates. This could easily be the reason for the osteoporosis in the cachectic individuals. Plus many will have been on long-term glucocorticoids, infamous for decreasing BMD. That may not explain all the low BMD, but would likely account for some of it, especially in people on long-term, high doses of the glucocorticoids. It is apparent that individuals with COPD need to request a referral to a specialist in diagnosis and treating osteoporosis. See the Osteoporosis Links at this site and click on Find an Endocrinologist or Rheumatologist. People with COPD should assume they have osteoporosis until proven otherwise to be on the safe side. No need to be dealing with broken bones along with your COPD health issues. Another important point is that "sufficient calcium and vitamin D" is not protective from low BMD in individuals with other factors responsible for osteoporosis and osteopenia as shown in the Jorgensen and others study. That is, if metabolic acidosis or glucocorticoid therapy cause the BMD problem, those are the issues that need to be addressed with an FDA-approved medication to treat osteoporosis. See this list at NOF.org.
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