Osteoporosis is a degenerative bone disease that results in low bone density which weakens bones and ultimately leads to frequent bone fractures. It has long been considered a condition that is often found in COPD patients. A new Dutch study published online ahead of print reveals that the prevalence of osteoporosis in COPD patients is likely much higher than previously reported – as high as 1 of every 2 COPD patients!
Why? According to the research team, “Most studies in COPD patients use dual energy absorptiometry (DXA) scan only to determine osteoporosis, therefore microarchitectural changes without a low BMD are missed. Aim of the current study was to determine the prevalence and correlates of osteoporosis in COPD patients based on DXA-scan, X-ray of the spine (X-spine) and the combination thereof.” (Graat-Verboom L, et al. Osteoporosis in COPD outpatients based on bone mineral density and vertebral fractures. Journal of Bone and Mineral Research. 2010 Sep 27. [Epub ahead of print])
In other words, in previous studies only one testing method (dual energy absorptiometry) has been typically used to make a diagnosis of osteoporosis in COPD patients and the researchers desired to know whether there would be an increase in diagnosed cases of osteoporosis in COPD patients by utilizing an alternative method (X-ray of the spine to identify vertebral fractures), and then by using both methods.
The study team discovered that dual energy absorpitometry only identified osteoporosis in 24% of the 255 COPD patients participating in the study, while spine X-rays identified osteoporosis in 37% of study subjects. When both methods were used in combination, the diagnosis of osteoporosis among the COPD patients in the study rose to 51%. As an interesting but frightening side note, 93 of the COPD patients in the study had spine fractures detected by X-Ray, but only 8 of these patients were aware prior to the X-Ray that they had fractured vertebrae.
Even more stunning was their discovery that the percentage of osteoporosis diagnosis was relatively consistent across the spectrum of mild, moderate, severe and very severe COPD patients – implying that osteoporosis is present early on in the development of COPD.
What leads to osteoporosis in COPD patients? Ironically, many of the same factors that tend to worsen shortness of breath…the combination of prolonged exposure to cigarette smoke, a sedentary lifestyle, inadequate exposure to sunlight, and low body weight due to poor/low nutritional intake.
As case in point, the researchers discovered that Vitamin D deficiency was present in over 86% of COPD patients in the study (when using the same deficiency cut-off level employed in diagnosing osteoporosis in post-menopausal women)! Vitamin D, as regular readers of our blog and e-letters well know, is typically produced in the body by skin-cell receptors that utilize UV-B rays from direct sunlight as a catalyst. Vitamin D is essential for the production and maintenance of healthy bones. Many COPD patients lead sedentary, indoor lifestyles and therefore do not get adequate exposure to sunlight. In addition, cigarette smoke has been shown to leach Vitamin D from the body. For COPD patients who don’t get adequate exposure to sunlight, a double whammy happens – it increases airway inflammation and leads to bone density loss. Click here to see our recent article about Vitamin D deficiency and airway inflammation.
Further, many COPD patients are physically inactive. Not only does this weaken the cardiovascular function and muscle strength/function, it also significantly weakens bones. You see, bone strength is reinforced by engaging in weight bearing tasks (walking and lifting weights for example). Because many COPD patients do not regularly exercise and instead spend significant portions of each day sitting/lying down, bone loss from lack of direct sunlight is compounded by lack of physical activity.
Further still, many COPD patients are significantly underweight. This is most often due to the combination of depressed appetite caused by the body’s chemical reaction to cigarette smoke, poor dietary caloric intake of protein & vital nutrients (including Vitamin D fortified foods), and a higher-than-normal metabolism due to the fact that COPD patients burn significantly more calories to take in/expel each breath – even at rest. Low body weight is highly correlated with osteoporosis – again because it means that less weight/load is placed on bones in the body.
So what can you do if you are concerned about the possibility that you might have osteoporosis? Well, first, it’s a good idea to ask your doctor to order both of the above mentioned diagnostic tests to determine if you have osteoporosis or osteopenia (a term doctors apply to low bone density that isn’t quite bad enough to call osteoporosis yet) – especially given the prevalence of previously undetected fractured vertebrae discovered in the Dutch study.
There are prescription drugs available that purportedly increase bone mass but they come with some significant and unpleasant side effects (as a side note, approximately 87% of the Dutch study subjects were NOT taking prescribed bone medication). In our opinion, your first best defenses to improve bone density are the same recommendations we make for improving shortness of breath in our Breathe Better for Life guide/CD, www.breathebetterforlife.com.
1. Start and maintain a regular exercise program that includes both cardiovascular training and strength training. Our Breathe Better for Life guide/CD 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!)
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).
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).
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