For the second time in less than a month, a new study has been published detailing the high rate of osteoporosis in COPD patients and revealing the low rate of testing and detection for this debilitating bone condition among those with lung disease.
For regular readers of our blog and e-letters, you will recall that we published an article earlier this month describing a new study that showed osteoporosis was present in 51% of COPD patients participating in the study. More alarming though was the presence of vertebral fractures in a significant percentage of these patients – many of whom had no idea they had such fractures! Click here to read the article.
Now comes a study published last week online ahead of print in the journal Osteoporosis International that demonstrates both the high incidence of osteoporosis in COPD patients and the poor rate of testing and detection of bone disease in this population – only on a significantly larger scale.
In this new study, a group of researchers from the Dartmouth Medical School examined the records of close to 90,000 male veterans who were newly diagnosed with COPD between 1999 and 2003 and who were receiving medical care through the Veterans Administration. (Morden NE, et al. Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures. Osteoporos Int. 2010 Oct 9. [Epub ahead of print]).
In particular the research team sought to determine whether the presence of osteoporosis was higher among male COPD patients in comparison to men of similar age in the U.S. population. Their results showed that the male COPD patients in the study had 256% higher incidence of hip fractures and 38% higher incidence of wrist fractures compared to males of similar age in the general U.S. population.
According to the study authors, “The fracture rate in this population was much higher than that reported in the literature for men in the general population between the ages of 65 and 69… The high fracture rate likely results from a confluence of risks that include medication exposure, inactivity, smoking, hypogonadism, underweight or weight loss as well as inadequate nutrition and effects of the chronic inflammation that characterizes COPD.”
Further, the investigators sought to understand the prevalence of bone mineral density testing and treatment for low bone density in the male COPD patients. They found that only 4% of the nearly 90,000 COPD patients had received a bone density test (either concurrent with their COPD diagnosis or thereafter). Of the 4% COPD patients who were tested for low bone density, approximately 75% were prescribed an osteoporosis-related medication – but that still means that only 3% of the total COPD study subjects were prescribed helpful medication.
We ask ourselves, if pulmonologists know that well over 50% of COPD patients likely have osteoporosis, why are they only testing 4% of newly diagnosed patients?
How can this be? It’s probably best to let the researchers speak for themselves, “Juxtaposed to the high rate of fragility fracture, the low rate of bone densitometry [testing] and anti-resporptive treatment in this population is striking. The association between osteoporosis and COPD was recognized as early as 1972, and confirmation of this association has repeatedly appeared in the literature since then. The low rate of treatment observed in this cohort [population] likely reflects the low rate of bone density testing which commonly prompts treatment. Of particular note is the fact that more COPD exacerbations were strongly associated with both higher probability of fracture and lower probability of testing or treatment. This may reflect physician and patient distraction as lung disease is prioritized over bone health or simply a lack of understanding of the association between COPD severity (and related treatments) and fracture.”
In other words, physicians seem more focused on treating lung disease and miss the opportunity to test COPD patients for osteoporosis. While one can understand the prioritization of care when a patient has experienced a COPD-related exacerbation, it is less understandable why there isn’t standard osteoporosis screening as part of the follow up process related to an exacerbation. This is especially puzzling given the observations of the Dartmouth study team, “In addition to being at high risk for osteoporosis and consequent fragility fractures, men with COPD may suffer particularly high mortality following a hip fracture…In addition to higher mortality, patients with COPD may suffer greater morbidity from osteoporosis as vertebral compression fractures may diminish lung volume and compromise already limited respiratory function.”
Therefore, my good friends, you appear to be in the driver’s seat on this topic. If you have COPD and you have not been tested/screened for osteoporosis, we would highly recommend that you asked to be tested. The study highlighted four different screening tests available for assessing osteoporosis risk including: dual energy X-ray studies, ultrasound for bone density measure, CT scan bone density, and bone mineral, single or dual photon.
Separately, you can help support both your respiratory function and bone density by altering your lifestyle by taking these valuable steps:
1. Start and maintain a regular exercise program that includes both cardiovascular training and strength training. Our Breathe Better for Life guide/CD, www.breathebetterforlife.com, provides a specific exercise program regimen formulated specifically for COPD patients and smokers based on the principles and practices of the COPD treatment pulmonary rehabilitation. Even a simple walking program that involves 20-40 minutes of walking 3-5 days each week will provide some protective value for both COPD symptoms and osteoporosis.
2. Increase your exposure to direct sunlight (without sunscreen lotion on that blocks UV-B rays)…meaning get outside with multiple parts of your body exposed to direct sunlight for 20-30 minutes a day (combine that with your walking program and you’re knocking off two important steps in one action!) Sunlight helps your body produce Vitamin D, an important nutrient in supporting healthy respiratory function and bones. COPD patients and smokers are known to be significantly deficient in Vitamin D.
3. Supplement your diet with foods rich in Vitamin D (and/or fortified with Vitamin D). For a good listing of Vitamin D rich foods, click here.
4. Consider adding a Vitamin D3 dietary supplement to your daily routine – we recommend 2,000 IU daily dosage (make sure your Vitamin D3 comes in the form of cholecalciferol). For those interested, we have included this dosage level in our new respiratory support supplement, Resplenish. To learn more about Resplenish, click here.
5. Increase protein sources to your daily diet – three particularly good sources that have been shown in previous studies to be associated with better respiratory function are soy isoflavones (soy bean sprouts, tofu, soy beans), fish and dairy products (both dairy products and fish are also rich sources of Vitamin D). Many COPD patients and smokers are underweight due to lack of adequate protein/nutrient intake. Protein is helpful in maintaining a healthy weight and healthy muscles – which are supportive of healthy bones.
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