Fracture prevention in COPD patients; a clinical 5-step approach

Respiratory Research

Emiel FM Wouters²  Peter ThW van Hal¹  Joop PW van den Bergh⁷  Frank WJM Smeenk⁶  Erica PA Rutten³  Willem F Lems⁵  Piet Geusens⁴  Elisabeth APM Romme⁶ 

[1] Department of Respiratory Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Belgium;Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, 6202 AZ, The Netherlands;Centre of expertise for chronic organ failure (CIRO+), Research and education, Haelen, 6080 AA, The Netherlands;Department of Rheumatology, Maastricht University Medical Centre+, Maastricht, 6202 AZ, The Netherlands;Department of Rheumatology, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands;Department of Respiratory Medicine, Catharina hospital, Eindhoven, 5602 ZA, The Netherlands;Department of Internal Medicine, VieCuri Medical Centre, Venlo, 5900 BX, The Netherlands

关键词: Therapy;    Prevention;    Fracture;    Osteoporosis;    COPD;   

Others  :  1135815
DOI  :  10.1186/s12931-015-0192-8

 received in 2014-11-23, accepted in 2015-02-14,  发布年份 2015

【 摘 要 】

Although osteoporosis and its related fractures are common in patients with COPD, patients at high risk of fracture are poorly identified, and consequently, undertreated. Since there are no fracture prevention guidelines available that focus on COPD patients, we developed a clinical approach to improve the identification and treatment of COPD patients at high risk of fracture. We organised a round-table discussion with 8 clinical experts in the field of COPD and fracture prevention in the Netherlands in December 2013. The clinical experts presented a review of the literature on COPD, osteoporosis and fracture prevention. Based on the Dutch fracture prevention guideline, they developed a 5-step clinical approach for fracture prevention in COPD. Thereby, they took into account both classical risk factors for fracture (low body mass index, older age, personal and family history of fracture, immobility, smoking, alcohol intake, use of glucocorticoids and increased fall risk) and COPD-specific risk factors for fracture (severe airflow obstruction, pulmonary exacerbations and oxygen therapy). Severe COPD (defined as postbronchodilator FEV₁ < 50% predicted) was added as COPD-specific risk factor to the list of classical risk factors for fracture. The 5-step clinical approach starts with case finding using clinical risk factors, followed by risk evaluation (dual energy X-ray absorptiometry and imaging of the spine), differential diagnosis, treatment and follow-up. This systematic clinical approach, which is evidence-based and easy-to-use in daily practice by pulmonologists, should contribute to optimise fracture prevention in COPD patients at high risk of fracture.

【 授权许可】

   
2015 Romme et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Burden of COPD [www.who.int/respiratory/copd/burden/en/index.html].
• [2]Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM: Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006, 28:523-32.
• [3]Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, et al.: Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res 2010, 11:122.
• [4]Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al.: Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease, GOLD Executive Summary. Am J Respir Crit Care Med 2012, 187:347-65.
• [5]Van Remoortel H, Hornikx M, Langer D, Burtin C, Everaerts S, Verhamme P, et al.: Risk factors and comorbidities in the preclinical stages of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014, 189:30-8.
• [6]Vanfleteren LE, Spruit MA, Groenen M, Gaffron S, van Empel VP, Bruijnzeel PL, et al.: Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013, 187:728-35.
• [7]Miller J, Edwards LD, Agusti A, Bakke P, Calverley PM, Celli B, et al.: Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med 2013, 107:1376-84.
• [8]Graat-Verboom L, Wouters EF, Smeenk FW, van den Borne BE, Lunde R, Spruit MA: Current status of research on osteoporosis in COPD: a systematic review. Eur Respir J 2009, 34:209-18.
• [9]Ogura-Tomomatsu H, Asano K, Tomomatsu K, Miyata J, Ohmori N, Kodama M, et al.: Predictors of osteoporosis and vertebral fractures in patients presenting with moderate-to-severe chronic obstructive lung disease. COPD 2012, 9:332-7.
• [10]Nuti R, Siviero P, Maggi S, Guglielmi G, Caffarelli C, Crepaldi G, et al.: Vertebral fractures in patients with chronic obstructive pulmonary disease: the EOLO Study. Osteoporos Int 2009, 20:989-98.
• [11]Morden NE, Sullivan SD, Bartle B, Lee TA: Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures. Osteoporos Int 2011, 22:1855-62.
• [12]Graat-Verboom L, van den Borne BE, Smeenk FW, Spruit MA, Wouters EF: Osteoporosis in COPD outpatients based on bone mineral density and vertebral fractures. J Bone Miner Res 2011, 26:561-8.
• [13]Harrison RA, Siminoski K, Vethanayagam D, Majumdar SR: Osteoporosis-related kyphosis and impairments in pulmonary function: a systematic review. J Bone Miner Res 2007, 22:447-57.
• [14]Regan EA, Radcliff TA, Henderson WG, Cowper Ripley DC, Maciejewski ML, Vogel WB, et al.: Improving hip fractures outcomes for COPD patients. COPD 2013, 10:11-9.
• [15]van den Bergh JP, van Geel TA, Geusens PP: Osteoporosis, frailty and fracture: implications for case finding and therapy. Nat Rev Rheumatol 2012, 8:163-72.
• [16]Richtlijn Osteoporose en Fractuurpreventie, derde herziening. [http://www.diliguide.nl/document/1015].
• [17]Kjensli A, Mowinckel P, Ryg MS, Falch JA: Low bone mineral density is related to severity of chronic obstructive pulmonary disease. Bone 2007, 40:493-7.
• [18]Jorgensen NR, Schwarz P: Osteoporosis in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med 2008, 14:122-7.
• [19]Bon J: Does radiographic emphysema correlate with low bone mineral density? Curr Opin Pulm Med 2012, 18:125-30.
• [20]Lehouck A, Boonen S, Decramer M, Janssens W: COPD, Bone Metabolism, and Osteoporosis. Chest 2011, 139:648-57.
• [21]van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C: Use of oral corticosteroids and risk of fractures. J Bone Miner Res 2000, 15:993-1000.
• [22]van Staa TP, Leufkens HG, Cooper C: The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 2002, 13:777-87.
• [23]Baptist AP, Reddy RC: Inhaled corticosteroids for asthma: are they all the same? J Clin Pharm Ther 2009, 34:1-12.
• [24]Allen DB, Bielory L, Derendorf H, Dluhy R, Colice GL, Szefler SJ: Inhaled corticosteroids: past lessons and future issues. J Allergy Clin Immunol 2003, 112:S1-40.
• [25]Pouw EM, Prummel MF, Oosting H, Roos CM, Endert E: Beclomethasone inhalation decreases serum osteocalcin concentrations. BMJ 1991, 302:627-8.
• [26]Yang IA, Clarke MS, Sim EH, Fong KM: Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012., 7Article ID CD002991
• [27]Loke YK, Cavallazzi R, Singh S: Risk of fractures with inhaled corticosteroids in COPD: systematic review and meta-analysis of randomised controlled trials and observational studies. Thorax 2011, 66:699-708.
• [28]Agusti A, Edwards LD, Rennard SI, MacNee W, Tal-Singer R, Miller BE, et al.: Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype. PLoS One 2012, 7:e37483.
• [29]Garcia-Rio F, Miravitlles M, Soriano JB, Munoz L, Duran-Tauleria E, Sanchez G, et al.: Systemic inflammation in chronic obstructive pulmonary disease: a population-based study. Respir Res 2010, 11:63. BioMed Central Full Text
• [30]Gan WQ, Man SF, Senthilselvan A, Sin DD: Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax 2004, 59:574-80.
• [31]Sinden NJ, Stockley RA: Systemic inflammation and comorbidity in COPD: a result of ‘overspill’ of inflammatory mediators from the lungs? Review of the evidence. Thorax 2010, 65:930-6.
• [32]MacNee W: Systemic inflammatory biomarkers and co-morbidities of chronic obstructive pulmonary disease. Ann Med 2013, 45:291-300.
• [33]Bai P, Sun Y, Jin J, Hou J, Li R, Zhang Q, et al.: Disturbance of the OPG/RANK/RANKL pathway and systemic inflammation in COPD patients with emphysema and osteoporosis. Respir Res 2011, 12:157. BioMed Central Full Text
• [34]Hardy R, Cooper MS: Bone loss in inflammatory disorders. J Endocrinol 2009, 201:309-20.
• [35]Redlich K, Smolen JS: Inflammatory bone loss: pathogenesis and therapeutic intervention. Nat Rev Drug Discov 2012, 11:234-50.
• [36]van der Goes MC, Jacobs JW, Jurgens MS, Bakker MF, van der Veen MJ, van der Werf JH, et al.: Are changes in bone mineral density different between groups of early rheumatoid arthritis patients treated according to a tight control strategy with or without prednisone if osteoporosis prophylaxis is applied? Osteoporos Int 2013, 24:1429-36.
• [37]Mathioudakis AG, Amanetopoulou SG, Gialmanidis IP, Chatzimavridou-Grigoriadou V, Siasos G, Evangelopoulou E, et al.: Impact of long-term treatment with low-dose inhaled corticosteroids on the bone mineral density of chronic obstructive pulmonary disease patients: aggravating or beneficial? Respirology 2013, 18:147-53.
• [38]Kneidinger N, Yildirim AO, Callegari J, Takenaka S, Stein MM, Dumitrascu R, et al.: Activation of the WNT/beta-catenin pathway attenuates experimental emphysema. Am J Respir Crit Care Med 2011, 183:723-33.
• [39]Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD: Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int 1993, 3:120-6.
• [40]Bartalena T, Rinaldi MF, Modolon C, Braccaioli L, Sverzellati N, Rossi G, et al.: Incidental vertebral compression fractures in imaging studies: Lessons not learned by radiologists. World J Radiol 2010, 2:399-404.
• [41]Genant HK, Wu CY, van KC, Nevitt MC: Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993, 8:1137-48.
• [42]Romme EA, Rutten EP, Smeenk FW, Spruit MA, Menheere PP, Wouters EF: Vitamin D status is associated with bone mineral density and functional exercise capacity in patients with chronic obstructive pulmonary disease. Ann Med 2012, 45:91-6.
• [43]Durup D, Jorgensen HL, Christensen J, Schwarz P, Heegaard AM, Lind B: A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: the CopD study. J Clin Endocrinol Metab 2012, 97:2644-52.
• [44]Balasubramanian V, Naing S: Hypogonadism in chronic obstructive pulmonary disease: incidence and effects. Curr Opin Pulm Med 2012, 18:112-7.
• [45]Bours SP, van den Bergh JP, van Geel TA, Geusens PP: Secondary osteoporosis and metabolic bone disease in patients 50 years and older with osteoporosis or with a recent clinical fracture: a clinical perspective. Curr Opin Rheumatol 2014, 26:430-9.
• [46]Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A: Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007, 370:657-66.
• [47]van den Bergh JP, Bours SP, van Geel TA, Geusens PP: Optimal use of vitamin D when treating osteoporosis. Curr Osteoporos Rep 2011, 9:36-42.
• [48]Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, et al.: Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 2008, 336:262-6.
• [49]Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, et al.: Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010, 341:c3691.
• [50]Romme EA, Smeenk FW, Rutten EP, Wouters EF: Osteoporosis in chronic obstructive pulmonary disease. Expert Rev Respir Med 2013, 7:397-410.
• [51]Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al.: Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012., 9Article ID CD007146
• [52]Graat-Verboom L, Smeenk FW, van den Borne BE, Spruit MA, Jansen FH, van Enschot JW, et al.: Progression of osteoporosis in patients with COPD: A 3-year follow up study. Respir Med 2012, 106:861-70.