An extremely high prevalence of osteopenia/osteoporosis exists among male folks with pulmonary disease, states a new study from researchers in California.
"While post-menopausal women are routinely screened for osteoporosis, men are not," said Kathleen Ellstrom, PhD, RN, APRN-BC, Pulmonary Clinical Nurse Specialist and Director of the Pulmonary Rehabilitation Program at the Veterans Administration Loma Linda Healthcare System. "The high prevalence of bone disease we found in male patients referred to our pulmonary rehabilitation program suggests that routine screening should also be performed in men with pulmonary disease."
The results will be presented at the ATS 2012 International Conference in San Francisco.
The study included 46 patients, 43 of whom underwent dual-emission X-ray absorptiometry (DXA) screening. The majority (98%) of patients were male. Diagnoses included chronic obstructive pulmonary disease (COPD, 80%), idiopathic pulmonary fibrosis (IPF, 16%), and asthma (4%).
Of the 43 patients who underwent DXA scanning, 27 (63%) had positive scans. Of these 27 patients, 21 (78%) had osteopenia and 6 (22%) had osteoporosis. The severity of lung disease was also associated with bone disease as those patients with more severe lung disease were more likely to also have bone disease.
"Smoking and the use of steroids to treat exacerbations in patients with lung disease are factors known to be associated with an increased risk of osteopenia/osteoporosis. In addition, recent evidence suggests that COPD itself may be associated with an increased risk secondary to an inflammatory process independent of steroid use," said Dr. Ellstrom.
"Our findings suggest that routine screening for osteopenia/osteoporosis in male patients with pulmonary disease may help reduce the occurrence of fractures in these patients by identifying at-risk individuals that might otherwise not be evaluated and treated."
"High Prevalence Of Osteopenia/Osteoporosis In Patients Referred For Pulmonary Rehabilitation" (Session A107, Sunday, May 20, 2:00- 4:30 p.m., Room 3010-3012, Moscone Center; Abstract 32409)
* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.
High Prevalence Of Osteopenia/Osteoporosis In Patients Referred For Pulmonary Rehabilitation
Type: Scientific Abstract
Category: 15.06 - Pulmonary Rehabilitation: Patient Assessment (PR)
Authors: K. Ellstrom, N.L. Specht; VA Loma Linda Healthcare System - Loma Linda, CA/US
INTRODUCTION: Recent studies implicate Chronic Obstructive Pulmonary Disease (COPD) in the development of osteopenia/osteoporosis secondary to an inflammatory process independent of steroid use. Additionally, the use of steroids for exacerbations in lung disease place patients at increased risk. Women are routinely screened for osteoporosis post-menopause, whereas men are not. We initiated Dual-emission X-ray Absorptiometry (DXA) screening for all patients referred to our pulmonary rehabilitation program in an attempt to assess bone density and intervene early if results were abnormal.
METHODS: As part of the routine intake into the pulmonary rehabilitation program for the past two years, patients were assessed to see if DXA scans had been done previously. If not, patients were sent for a DXA scan. If the results were abnormal, medications were prescribed: alendronate 70 mg weekly, calcium 500 mg and vitamin D 2000u daily.
This data has been collated and analyzed to assess the incidence of osteopenia/osteoporosis in our Veterans Administration pulmonary rehabilitation patient population.
RESULTS: Forty-three of 46 patients completed the DXA scan. Ages ranged from 47-91 years (mean 68.9); 98% were male; ethnicities were 72% White, 17% Black, and 11% Hispanic/Latino. Diagnosis was COPD (80%), 16% Idiopathic Pulmonary Fibrosis (IPF) and 4% Asthma. Post-bronchodilator FEV1 ranged from 12% to 83% of predicted, with the higher ones mostly in the IPF patients; 33% were GOLD Stage II, 48% were Stage III, and 19% had Stage IV disease. Fifty-nine percent had a high C-reactive protein level.
Of the 43 patients who completed the scan, 63% (n=27) had a positive DXA scan. Of those, 78% (n=21) had osteopenia and 22% (n=6) showed osteoporosis.
CONCLUSIONS: Male veterans with pulmonary disease are at risk for bone disease. The prevalence of osteopenia/osteoporosis is very high in this population and routine screening may help to reduce fractures.