Associated Loss of Fat-free Mass and Bone Mineral Density in Chronic Obstructive Pulmonary Disease

Bolton, Charlotte E.; Ionescu, Alina; Shiels, K.; Pettit, Rebecca; Edwards, P.; Stone, Michael D.; Nixon, Lisette Sheena; Evans, W. D.; Griffiths, Timothy; Shale, Dennis J.

doi:10.1164/rccm.200406-754oc

Cited by 300 publications

(265 citation statements)

References 57 publications

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“…COPD and bronchial asthma are risk factors for osteoporosis; these patients often display a loss of significant amounts of both cortical and trabecular bone [1][2][3][4][5][6][7][8][9]. These patients are also often treated with oral or inhaled glucocorticoids and this contributes to significant additional bone loss.…”

Section: Discussionmentioning

confidence: 99%

“…the prevalence of reduced bone density and vertebral fractures in patients with chronic obstructive pulmonary disease (COPD) is high [1][2][3][4]; furthermore case-control studies have confirmed reduced bone mineral density (BMD) in COPD patients compared with controls [5][6], even in those with milder disease [7] while in patients who have osteoporosis and spinal deformities, reduced pulmonary function is related to the severity of osteoporosis [9][10][11] in the same way that the worse the level of lung function in COPD patients, the greater the likelihood of low BMD [12].…”

Section: Introductionmentioning

confidence: 99%

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Is lung function associated with bone mineral density? Results from the Hertfordshire Cohort Study

et al. 2013

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Purpose-There is limited information available regarding the association between lung function and bone mineral density among healthy elderly subjects. We addressed this issue in the Hertfordshire Cohort Study.Methods-985 subjects (496 men and 489 women) aged 60-72 years were recruited from the above cohort. All subjects underwent bone density measurements using dual energy X-ray absorptiometry (DXA), and lung function tests using standardised spirometry. Chronic obstructive pulmonary disease (COPD) was defined as a Forced Expiratory Volume in 1 second (FEV 1) / Forced Vital Capacity (FVC) ratio < lower limit of normal (LLN), calculated using separate equations for men and women.Results-Measures of lung function (FEV 1 , FVC, FEV 1 /FVC) were not associated with bone mineral density at the lumbar spine, femoral neck and total hip in men or women; associations with bone mineral content and bone area were removed by adjustment for body size and lifestyle confounders. In this cohort, there were no associations observed between COPD and any measure of bone mass.Conclusions-There was no association between lung function and bone mass in this community dwelling cohort after adjustment for body size and other confounders.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is lung function associated with bone mineral density? Results from the Hertfordshire Cohort Study

et al. 2013

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“…Low BMD is correlated with reduced FFM in COPD patients [125]. However, COPD itself may be a risk factor for osteoporosis and this may be related to systemic inflammation.…”

Section: Osteoporosismentioning

confidence: 94%

Systemic manifestations and comorbidities of COPD

Barnes¹,

Celli²

2009

Eur Respir J

1,476

1,113

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Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction. Airflow obstruction has profound effects on cardiac function and gas exchange with systemic consequences. In addition, as COPD results from inflammation and/or alterations in repair mechanisms, the ''spill-over'' of inflammatory mediators into the circulation may result in important systemic manifestations of the disease, such as skeletal muscle wasting and cachexia. Systemic inflammation may also initiate or worsen comorbid diseases, such as ischaemic heart disease, heart failure, osteoporosis, normocytic anaemia, lung cancer, depression and diabetes. Comorbid diseases potentiate the morbidity of COPD, leading to increased hospitalisations, mortality and healthcare costs. Comorbidities complicate the management of COPD and need to be evaluated carefully. Current therapies for comorbid diseases, such as statins and peroxisome proliferator-activated receptor-agonists, may provide unexpected benefits for COPD patients. Treatment of COPD inflammation may concomitantly treat systemic inflammation and associated comorbidities. However, new broad-spectrum anti-inflammatory treatments, such as phosphodiesterase 4 inhibitors, have significant side-effects so it may be necessary to develop inhaled drugs in the future. Another approach is the reversal of corticosteroid resistance, for example with effective antioxidants. More research is needed on COPD comorbidities and their treatment.

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“…Furthermore, fat mass may be redistributed from subcutaneous to visceral adipose tissue, which has been associated with increased cardiovascular risk in mild to moderate COPD [20]. COPD patients with underweight or low FFM are more prone to loss of BMD than overweight patients [21]. DEXA is most appropriate for combined screening of osteoporosis, FFM and fat mass.…”

Section: Metabolic Phenotypes and Nutritional Risk Profile In Copdmentioning

confidence: 99%

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

et al. 2014

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Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of costeffectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk. @ERSpublications Metabolism and nutrition: shifting paradigms in COPD management

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Associated Loss of Fat-free Mass and Bone Mineral Density in Chronic Obstructive Pulmonary Disease

Cited by 300 publications

References 57 publications

Is lung function associated with bone mineral density? Results from the Hertfordshire Cohort Study

Is lung function associated with bone mineral density? Results from the Hertfordshire Cohort Study

Systemic manifestations and comorbidities of COPD

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

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