Whole-Body versus Local DXA-Scan for the Diagnosis of Osteoporosis in COPD Patients

Background. Osteoporosis is an extrapulmonary effect of chronic obstructive pulmonary disease (COPD). Diagnosis of osteoporosis is based on BMD measured by DXA-scan. The best location for BMD measurement in COPD has not been determined. Aim of this study was to assess whole-body BMD and BMD of the hip and lumbar spine (local DXA) in COPD patients and compare the prevalence of osteoporosis at these locations. Methods. Whole body as well as local DXA-scan were made in 168 COPD patients entering pulmonary rehabilitation. Patient-relevant characteristics were assessed. Prevalence of osteoporosis was determined. Characteristics of patients without osteoporosis were compared to patients with osteoporosis on local DXA. Results. A higher prevalence of osteoporosis was found using local DXA compared to whole-body DXA (39% versus 21%). One quarter of patients without osteoporosis on whole body-DXA did have osteoporosis on local DXA. Significant differences in patient characteristics between patients without osteoporosis based on both DXA measurements and patients with osteoporosis based on local DXA only were found. Conclusions. DXA of the hip and lumbar spine should be made to assess bone mineral density in COPD patients. The lowest T-score of these locations should be used to diagnose osteoporosis

Progression of osteoporosis in patients with COPD: A 3-year follow up study

SummaryCurrently, our knowledge on the progression of osteoporosis and its determinants is limited in patients with chronic obstructive pulmonary disease (COPD). Bone mineral density generally remains stable in patients with COPD over a period of 3 years. Nevertheless, the progression of vertebral fractures was not assessed, while an increase of vertebral fractures over time may be reasonable.Aims of the current study were to determine the percentage of newly diagnosed osteoporotic patients after a follow up of 3 years and to identify baseline risk factors for the progression of osteoporosis in COPD.Clinically stable COPD outpatients were included. Lung function parameters, body composition measures, six minute walk distance, DXA-scan and X-spine were assessed at baseline and repeated after 3 years.Prevalence of osteoporosis in COPD patients increased from 47% to 61% in 3 years mostly due to an increase of vertebral fractures. Lower baseline T-score at the trochanter independently increased the risk for the development of osteoporosis. Additionally, baseline vitamin D deficiency increased this risk 7.5-fold.In conclusion, the prevalence of osteoporosis increased over a 3-year period in patients with COPD. Baseline risk factors for the development of osteoporosis are osteopenia at the trochanter and vitamin D deficiency

History of chronic disease is a novel intrinsic risk factor associated with gradual onset injuries in recreational road cyclists: A cross-sectional study in 21,824 cyclists - SAFER XIV

Objectives: Risk factors related to Gradual onset injuries (GOIs) in cyclists need to be identified to enable effective injury prevention strategies. We aim to determine risk factors related to GOIs in cyclists participating in mass community-based events. Design: Cross-sectional study. Setting: Cape Town Cycle Tour. Participants: Race entrants (n = 35,914) Main outcome measures: Completion of pre-race medical questionnaires. 21,824 consenting cyclists (60.8%) were studied. 617 cyclists reported GOIs. Selected risk factors associated with GOIs: demographics, training/racing history, chronic disease history, and medication use, were explored using multi-variate analyses. Results: Prevalence ratio (PR) of GOIs was similar in males and females, but higher in older age categories [>50 yrs vs. categories: ≤30yrs (PR = 1.6); 31 to ≤40yrs (PR = 1.5); 41 to <50yrs (PR = 1.4)] (p < 0.0001). Intrinsic risk factors associated with GOIs (adjusted for gender and age) were: 1) increased weekly training/racing frequency (PR = 1.1, p = 0.0003), 2) chronic disease history [cardiovascular disease symptoms (PR = 2.3, p = 0.0026), respiratory disease (PR = 1.6, p < 0.0001), nervous system/psychiatric disease (PR = 1.5, p = 0.0082)], and 3) history of analgesic/anti-inflammatory medication (AAIM) used before/during racing (PR = 5.1, p < 0.0001)

A systematic review of the role of vitamin insufficiencies and supplementation in COPD

<p>Abstract</p> <p>Background</p> <p>Pulmonary inflammation, oxidants-antioxidants imbalance, as well as innate and adaptive immunity have been proposed as playing a key role in the development of COPD. The role of vitamins, as assessed either by food frequency questionnaires or measured in serum levels, have been reported to improve pulmonary function, reduce exacerbations and improve symptoms. Vitamin supplements have therefore been proposed to be a potentially useful additive to COPD therapy.</p> <p>Methods</p> <p>A systematic literature review was performed on the association of vitamins and COPD. The role of vitamin supplements in COPD was then evaluated.</p> <p>Conclusions</p> <p>The results of this review showed that various vitamins (vitamin C, D, E, A, beta and alpha carotene) are associated with improvement in features of COPD such as symptoms, exacerbations and pulmonary function. High vitamin intake would probably reduce the annual decline of FEV1. There were no studies that showed benefit from vitamin supplementation in improved symptoms, decreased hospitalization or pulmonary function.</p

Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures

This narrative review considers the key challenges facing healthcare professionals and policymakers responsible for providing care to populations in relation to bone health. These challenges broadly fall into four distinct themes: (1) case finding and management of individuals at high risk of fracture, (2) public awareness of osteoporosis and fragility fractures, (3) reimbursement and health system policy and (4) epidemiology of fracture in the developing world. Findings from cohort studies, randomised controlled trials, systematic reviews and meta-analyses, in addition to current clinical guidelines, position papers and national and international audits, are summarised, with the intention of providing a prioritised approach to delivery of optimal bone health for all. Systematic approaches to case-finding individuals who are at high risk of sustaining fragility fractures are described. These include strategies and models of care intended to improve case finding for individuals who have sustained fragility fractures, those undergoing treatment with medicines which have an adverse effect on bone health and people who have diseases, whereby bone loss and, consequently, fragility fractures are a common comorbidity. Approaches to deliver primary fracture prevention in a clinically effective and cost-effective manner are also explored. Public awareness of osteoporosis is low worldwide. If older people are to be more pro-active in the management of their bone health, that needs to change. Effective disease awareness campaigns have been implemented in some countries but need to be undertaken in many more. A major need exists to improve awareness of the risk that osteoporosis poses to individuals who have initiated treatment, with the intention of improving adherence in the long term. A multisector effort is also required to support patients and their clinicians to have meaningful discussions concerning the risk-benefit ratio of osteoporosis treatment. With regard to prioritisation of fragility fracture prevention in national policy, there is much to be done. In the developing world, robust epidemiological estimates of fracture incidence are required to inform policy development. As the aging of the baby boomer generation is upon us, this review provides a comprehensive analysis of how bone health can be improved worldwide for all

Osteoporosis in chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary diseases (COPD) not only have a disease that disorders the lung function, but they always run a higher risk of getting other diseases, such as osteoporosis. . Half of all COPD patients that are monitored by a lung specialist turn out to have osteoporosis, independently from the seriousness of the COPD. Most COPD patients with osteoporosis, however, do not take medication to reduce the risk of fractures, which indicates unfamiliarity with the phenomenon among (lung) specialists. This awareness has to be awakened. The underlying factors that increase the risk of osteoporosis in COPD patients have not yet been clarified. This dissertation points among others in the direction of a lower body weight and lower fat free mass, vitamin D shortage and a lower bone density of the hip. Follow-up research, however, will have to confirm or invalidate this