Frequency of Osteoporosis and Vertebral Fractures in Chronic Obstructive Pulmonary Disease (COPD) Patients

Gazzotti, Mariana Rodrigues; Roco, Carolina M.; Pradella, Cristiane O.; Nascimento, Oliver Augusto; Pôrto, Elias Ferreira; Adas, Mariana; Lazaretti‐Castro, Marise; Jardim, José Roberto

doi:10.1016/j.arbres.2018.10.010

Cited by 11 publications

(6 citation statements)

References 27 publications

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“…To date, current recommendations do not support using ICS to improve shortness of breath or symptom control in COPD. [6][7][8] However, our findings emphasize poor adherence to these recommendations, and suggest that physicians could be inclined to prescribing ICS not only for prevention of exacerbations but also for symptom control. Our results concur with other recent studies that confirmed the association between symptoms and ICS prescription.…”

mentioning

confidence: 71%

“… 20–22 Prescribing ICS only when recommended is relevant to avoid the potential risk of side effects, since long-term use of ICS has showed a higher prevalence and incidence of serious side effects such as pneumonia, osteoporosis, diabetes, and others, beyond increasing healthcare expenditure among COPD patients. 8 , 9 , 23 …”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] Prescribing ICS only when recommended is relevant to avoid the potential risk of side effects, since long-term use of ICS has showed a higher prevalence and incidence of serious side effects such as pneumonia, osteoporosis, diabetes, and others, beyond increasing healthcare expenditure among COPD patients. 8,9,23 Several guidelines have recognized the need to withdraw ICS in patients without indications. 10,13,24,25 However, a considerable proportion of patients continue receiving ICS despite not having a clear indication.…”

Section: Discussionmentioning

confidence: 99%

“… 5 Different clinical guidelines have recognized the usefulness of inhaled corticosteroids (ICS) in patients with frequent exacerbations despite optimal bronchodilator treatment, by decreasing the number of exacerbations and improving quality of life. 6 , 7 However, long-term use of ICS is associated with an increased risk of significant side-effects, 8 , 9 for which ICS should be reserved for individuals at high exacerbation risk.…”

Section: Introductionmentioning

confidence: 99%

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Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain

Miravitlles

Román-Rodríguez

Ribera

et al. 2022

COPD

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Purpose Inhaled corticosteroids (ICS) are frequently used to treat chronic obstructive pulmonary disease (COPD) outside the current recommendations. Our aim was to describe ICS use in COPD patients and to identify factors associated with ICS use among COPD patients treated within primary care in Spain. Patients and Methods This was a cross-sectional, non-interventional and multicenter study of patients with COPD treated in primary care. Patient characteristics and exacerbations were described in terms of ICS use among the overall cohort, and among those with spirometry confirmed COPD (post-bronchodilator forced expiratory volume in 1 second [FEV 1 ]/forced vital capacity [FVC] ratio <70%). Multivariable logistic regression was used to identify factors associated with ICS use. Results A total of 901 patients were included, of which 47.9% (n = 432) were treated with ICS. A total of 240 patients (26.6%) experienced moderate/severe exacerbations in the prior year, while 309 (34.3%) during the previous two years. History of asthma totaled 11.6% (n = 105). The most frequent phenotype was non-exacerbator (51.6%), and the proportion of patient with moderate or severe exacerbations was significantly higher among ICS treated patients compared to non-treated: 37.5% versus 16.6% during the previous year (p < 0.001), and 46.8% versus 22.8% during the previous 2-years (p < 0.001), respectively. Patient characteristics were similar among spirometry confirmed patients and the overall population. Factors significantly associated with ICS use were a history of asthma (OR = 4.39, 95% CI: 2.67–7.26), the presence of moderate or severe exacerbations in the last year (OR = 2.52, 95% CI: 1.81–3.49), followed by higher mMRC and higher CAT score. Conclusion Nearly half of patients in primary care in Spain are treated with ICS, despite most of them being non-exacerbators. History of asthma, exacerbations, and worse dyspnea and CAT scores are associated with ICS use.

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confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain

Miravitlles

Román-Rodríguez

Ribera

et al. 2022

COPD

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“…Osteoporosis, a systemic skeletal disease characterized by low bone mineral density(BMD) and/or microarchitectural deterioration of bone, is another common comorbidity of COPD, which is associated with increased bone fragility/ fracture, lower mobility and alteration in postural balance (12). A latest meta-analysis reported that the overall pooled prevalence of osteoporosis in patients with COPD was 38% (95%CI, 34%-43%), and BMI<18.5 kg/m 2 and the presence of sarcopenia were significant risk factors for osteoporosis in COPD (13).…”

Section: Skeletal Muscle and Bone Comorbidities In Copdmentioning

confidence: 99%

Muscle-Bone Crosstalk in Chronic Obstructive Pulmonary Disease

Zhang

Sun

2021

Front. Endocrinol.

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Sarcopenia and osteoporosis are common musculoskeletal comorbidities of chronic obstructive pulmonary disease (COPD) that seriously affect the quality of life and prognosis of the patient. In addition to spatially mechanical interactions, muscle and bone can also serve as endocrine organs by producing myokines and osteokines to regulate muscle and bone functions, respectively. As positive and negative regulators of skeletal muscles, the myokines irisin and myostatin not only promote/inhibit the differentiation and growth of skeletal muscles, but also regulate bone metabolism. Both irisin and myostatin have been shown to be dysregulated and associated with exercise and skeletal muscle dysfunction in COPD. During exercise, skeletal muscles produce a large amount of IL-6 which acts as a myokine, exerting at least two different conflicting functions depending on physiological or pathological conditions. Remarkably, IL-6 is highly expressed in COPD, and considered to be a biomarker of systemic inflammation, which is associated with both sarcopenia and bone loss. For osteokines, receptor activator of nuclear factor kappa-B ligand (RANKL), a classical regulator of bone metabolism, was recently found to play a critical role in skeletal muscle atrophy induced by chronic cigarette smoke (CS) exposure. In this focused review, we described evidence for myokines and osteokines in the pathogenesis of skeletal muscle dysfunction/sarcopenia and osteoporosis in COPD, and proposed muscle-bone crosstalk as an important mechanism underlying the coexistence of muscle and bone diseases in COPD.

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