Jørgensen N R, Schwarz P, Holme I, Henriksen B M, Petersen L J, Backer V
Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark.
Respir Med. 2007 Jan;101(1):177-85. doi: 10.1016/j.rmed.2006.03.029. Epub 2006 May 4.
Chronic obstructive pulmonary disease (COPD) is a complex disease, where the initial symptoms are often cough as a result of excessive mucus production and dyspnea. With disease progression several other symptoms may develop, and patients with moderate to severe COPD have often multiorganic disease with severely impaired respiratory dysfunction, decreased physical activity, right ventricular failure of the heart, and a decreased quality of life. In addition osteoporosis might develop possibly due to a number of factors related to the disease. We wanted to investigate the prevalence of osteoporosis in a population of patients with severe COPD as well as to correlate the use of glucocorticoid treatment to the occurrence of osteoporosis in this population. Outpatients from the respiratory unit with COPD, a history of forced expiratory volume in 1s (FEV1) less than 1.3 L, with FEV1% pred. ranging from 17.3% to 45.3% (mean 31.4%, standard deviation (sd) 7.3%). Patients between 50 and 70 years were included. Other causes of osteoporosis were excluded before inclusion. At study entry spirometry, X-ray of the spine (to evaluate presence of vertebral fractures), and bone mineral density of lumbar spine and hip were performed. Of 181 patients invited by mail, 62 patients were included (46 females and 16 males). All had symptoms of COPD such as exertional dyspnea, productive cough, limitations in physical activity etc. The mean FEV1 was 0.90 L (sd: 0.43 L) and the mean FEV1% pred. of 32.6% (sd: 14.1%). All had sufficient daily intake of calcium and vitamin D. In 15 patients, X-ray revealed compression fractures previously not diagnosed. Bone density measurements showed osteoporosis in 22 patients and osteopenia in 16. In total, 26 of the COPD patients were osteoporotic as evaluated from both X-ray and bone density determinations. Thus 68% of the participants had osteoporosis or osteopenia, but glucocorticoid use alone could not explain the increased prevalence of osteoporosis. A large fraction of these needed treatment for severe osteoporosis in order to prevent further bone loss and to reduce future risk of osteoporotic fractures. Thus, there is a significant need to screen patients with COPD to select the individuals in risk of fracture and to initiate prophylaxis or treatment for the disease.
慢性阻塞性肺疾病（COPD）是一种复杂的疾病，其初始症状通常是由于黏液分泌过多导致的咳嗽和呼吸困难。随着疾病进展，可能会出现其他几种症状，中重度COPD患者常伴有多器官疾病，呼吸功能严重受损，身体活动减少，心脏右心室衰竭，生活质量下降。此外，可能由于与该疾病相关的多种因素，骨质疏松症也可能会发生。我们想要调查重度COPD患者群体中骨质疏松症的患病率，并将糖皮质激素治疗的使用情况与该群体中骨质疏松症的发生情况相关联。呼吸科的门诊COPD患者，1秒用力呼气容积（FEV1）病史小于1.3L，FEV1%预计值范围为17.3%至45.3%（平均31.4%，标准差（sd）7.3%）。纳入年龄在50至70岁之间的患者。在纳入之前排除骨质疏松症的其他病因。在研究开始时进行肺活量测定、脊柱X线检查（以评估椎体骨折的存在情况）以及腰椎和髋部的骨密度检查。在通过邮件邀请的181名患者中，有62名患者被纳入（46名女性和16名男性）。所有患者都有COPD症状，如劳力性呼吸困难、咳痰、身体活动受限等。平均FEV1为0.90L（sd：0.43L），平均FEV1%预计值为32.6%（sd：14.1%）。所有患者每日钙和维生素D摄入量充足。在15名患者中，X线检查发现了先前未诊断出的压缩性骨折。骨密度测量显示22名患者患有骨质疏松症，16名患者患有骨质减少症。根据X线检查和骨密度测定评估，总共有26名COPD患者患有骨质疏松症。因此，68%的参与者患有骨质疏松症或骨质减少症，但仅使用糖皮质激素无法解释骨质疏松症患病率的增加。这些患者中的很大一部分需要接受重度骨质疏松症的治疗，以防止进一步的骨质流失并降低未来骨质疏松性骨折的风险。因此，非常有必要对COPD患者进行筛查，以选择有骨折风险的个体，并启动该疾病的预防或治疗。
