Links Between COPD and Osteoporosis
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A secondary condition that sometimes occurs with COPD is Osteoporosis. What is this? Can it be prevented or reversed? Here’s all you need to know.

What is Osteoporosis?

Your bones are made of living tissue. As older bone tissue breaks down new bone tissue is created. When your body doesn’t have the nutrients to create enough new bone tissue to keep up with the loss of old bone tissue, your bones may become weak and fragile. When this occurs the risk for fractures is greatly increased. (1-4, 6)

What are fractures? This is the term generally used to describe when a bone cracks or breaks. Osteoporotic bones are easily fractured, even from a fall that would otherwise have been harmless. Fractures to be concerned about are.

  • Rib. These can break during strong coughing spasms, and this can make it increasingly difficult to breathe, and even result in flare-ups. Rib fractures may also increase the risk of developing pneumonia, which can cause COPD flare-ups.
  • Arms/ Wrists. Even a simple bump might cause arm fractures, which can make it difficult to perform routine daily activities. However, of greatest concern are breaks of the…
  • Legs. COPD can make it difficult to stay physically active, and breaks in your legs can make it increasingly difficult to move around. This can result in a reduction in the quality of life, increased need for health care services, and even nursing home stays. (2-3)
  • Hips. Like leg fractures, they make it increasingly difficult to stay active and also increase the need for healthcare services due to the need for surgery services, and nursing home stays for rehabilitation. (2, 3)
  • Spine. This causes pain making it difficult to fully expand the rib cage. They often go undiagnosed and may result in further progression of osteoporosis and sometimes spinal changes that result in further loss of lung function. (2-5)

Some statistics

 The prevalence of osteoporosis in the general population tends to be greater among women than men.  However, the prevalence among the COPD population tends to affect women and men equally. But, it does seem to become increasingly prevalent as the disease progresses and becomes more severe.  According to one study, about 35% of those living with COPD were also diagnosed with osteoporosis. (2-3, 5-6)

Why is increased awareness important? Osteoporosis is considered an invisible illness, meaning that you cannot see it, and most don’t even know they have it until they fall and fracture a bone. In fact, one study showed that a whopping 82% of those with both conditions were not receiving treatment for osteoporosis. This spotlights the need for increased awareness not just among the COPD community, but also among those responsible for diagnosing and treating it. (2, 5-6)

Why do COPD patients develop osteoporosis?

Researchers don’t know the exact reason why COPD and osteoporosis often coexist, although they have a variety of theories. Some theories include but are not limited to…

  • Cigarette smoking. There are over 4,000 chemicals in cigarette smoke, and some researchers believe some of these chemicals cause changes inside your body, including genetic changes, that may cause bones to become weak and slow to heal. (1)
  • Corticosteroids. These are commonly used to reduce airway inflammation to prevent and control COPD flare-ups, and a common side effect is osteoporosis. Inhaled steroids are generally considered safe, although some of the medicine (about 10-40%) can still get into your system through pulmonary blood vessels. So, there remains a 9% increased risk of osteoporosis when taking inhaled corticosteroids. The greatest risk is when systemic corticosteroids are needed long-term. The risk usually begins about 3-6 months after beginning treatment and declines once treatment is stopped. (1, 5)
  • Inactivity. Fear that exertion will cause shortness of breath often results in a sedentary lifestyle, which may cause skeletal muscle weakness, especially in your legs. Long-term inactivity may cause leg muscle wasting and osteoporosis.  (1)
  • Low Testosterone. Cigarette smoking, corticosteroids, among other factors, are suspected of causing a reduction in the production of testosterone, especially in men. Low testosterone has been linked with both muscle wasting and osteoporosis. (1, 2)
  • Low Vitamin D. This is the sun vitamin. Does a low vitamin D level somehow contribute to lung diseases like asthma and COPD? Or do lung diseases cause indoor living and lack of exposure to the sun?  In either case, low vitamin D levels have been linked with poor skeletal muscle and bone growth and may contribute to muscle wasting and osteoporosis. (1)
  • Malnutrition. This is a concern in less than 35% of patients with COPD. This happens when you don’t eat enough, especially during severe COPD flare-ups, or when your body has to exert lots of energy to function. It’s also prevalent in those requiring hospital stays for flare-ups.  It usually results in unintentional weight loss.  Malnutrition has been linked with frequent flare-ups and re-admission. Severe malnutrition has been linked with both skeletal muscle loss and osteoporosis. (1)
  • Systemic inflammation. The immune system responds to chronic exposure to inhaled irritants by releasing a variety of chemicals into your lungs, resulting in inflammation that damages cells in a way that gradually causes emphysema and chronic bronchitis. These same chemicals can get into your bloodstream and travel to various other bodily systems, including skeletal tissue. These chemicals can damage skeletal tissue in a way that causes osteoporosis. (5)

Can it be prevented or treated?

The importance of quitting smoking, if you smoke, cannot be understated. Likewise, the same can be said of maintaining a physically active lifestyle and eating a proper diet. This is why it’s so important to work with your doctor, and possibly seeing other health experts, such as dieticians and physical therapists. Participating in a pulmonary rehabilitation program should prove useful.  Fall prevention training as a part of pulmonary rehabilitation should also prove useful. (1)

What will the future bring? There is an ongoing quest to learn more about the links between osteoporosis and COPD. The belief is that better wisdom may bring about better strategies for preventing COPD-related osteoporosis. In fact, some researchers are working on creating guidelines to help physicians to recognize who is at risk, and how to best diagnose and treat it. Further research should also eventually bring about alternative medicines that are more effective and safer than corticosteroids. Other medicines for treating osteoporosis are currently being studied. Nutritional supplementation, Vitamin D supplementation, calcium supplementation, testosterone replacement, and other therapies are also being studied and may prove useful. (1, 5)

What does this mean for you?

Keep in mind that not everyone with COPD will develop osteoporosis. Still, the fact that the risk exists highlights the importance of educating yourself about your disease — which you are doing right now — and working with your doctor on developing strategies for keeping you physically active so you can live better and live longer with COPD.

 

view references
  1. “Osteoporosis,” Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/osteoporosis/home/ovc-20207808, accessed 6/10/17
  2. Nele, Cielen, Karen Maes, Ghislaine Gayen-Ramirez, "Musculoskeletal Disorders in Chronic Obstructive Pulmonary Disease," Biomed Research International, 2014, https://www.hindawi.com/journals/bmri/2014/965764/, 5/31/17
  3. Sarkar, Malay, et al., “Osteoporosis in Chronic Obstructive Pulmonary Disease,” Clinical Medical Insights: Circulatory Respiratory Pulmonary Medicine, 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358421/, accessed 6/10/17
  4. Lehouck, “COPD, Bone Metabolism, and Osteoporosis,” Chest, 2011, https://www.ncbi.nlm.nih.gov/pubmed/21362651, accessed 6/20/17
  5. Romme, “Fracture Prevention in COPD: A clinical 5-step approach,” Respiratory Research, 2014, https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-015-0192-8, accessed 6/20/17
  6. Inoue D., Watanabe R., Okazaki R., "COPD and Osteoporosis: links, risks, and treatment challenges," International Journal of Obstructive Pulmonary Disease, 2015, https://www.dovepress.com/copd-and-osteoporosis-links-risks-and-treatment-challenges-peer-reviewed-fulltext-article-COPD, accessed 6/30/17
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