Assessment of Osteoporosis and Osteopenia ... - OMICS International

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Apr 21, 2018 - Daga MK*, Bharali D, Gupta B, Mawari G and Hira HS. Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, ...
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ISSN: 2161-105X

Daga et al., J Pulm Respir Med 2018, 8:2 DOI: 10.4172/2161-105X.1000456

Journal of

Pulmonary & Respiratory Medicine

Research Article

Open Access

Assessment of Osteoporosis and Osteopenia and its Co-Relation with Disease Severity in Patients of Chronic Obstructive Pulmonary Disease with Respect to Associated Risk Factors: A Case Control Study in India Daga MK*, Bharali D, Gupta B, Mawari G and Hira HS Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India

Abstract Introduction: Chronic obstructive pulmonary disease (COPD) is the major cause of morbidity and mortality which results in an economic and social burden. Osteoporosis is considered as one of the major systemic manifestations of COPD. Aim and Objective: It is to determine the prevalence of osteoporosis in COPD patients and its disease severity and also to evaluate various risk factors involved in reduced bone mineral density in patients with COPD. Methods: A total of 30 COPD patients and 15 healthy controls were enrolled and all individuals were subjected to pulmonary function test and DEXA scan. Various risk factors for COPD associated with osteoporosis and association of osteoporosis with severity of COPD were studied and analyzed. Statistical analysis was done for parametric data using t-test. p value 35 yr was 3.49% (ranging 1.1% in Mumbai to 10% in Thiruvananthapuram) [4]. Risk factors such as cigarette smoking, genetic risk factor, inhalational exposures such as tobacco smoke and occupational dusts and chemicals (vapors, irritants, and fumes) are commonly encountered risk factor for COPD [5,6]. The genetic risk factor that is best documented is a severe hereditary deficiency of alpha-1 antitrypsin [6]. Indoor air pollution, especially from burning biomass fuels in confined spaces, is associated with increased risk for COPD in developing countries, especially among women. The most common co morbidities responsible for the clinical manifestations and natural history of COPD co-morbidities are cachexia, skeletal muscle abnormalities, osteoporosis, metabolic syndrome, coronary artery disease, heart failure, pulmonary infections, cancer and pulmonary vascular disease [7]. J Pulm Respir Med, an open access journal ISSN: 2161-105X

Osteoporosis, with resulting fractures is one such major co-morbid condition in patients with advanced COPD [8]. The prevalence of osteoporosis in COPD patients is 36% to 60% and that of osteopenia is 35% to 72% [9]. Usually, the loss of bone occurs over an extended period of years. Moreover, COPD patients have a higher risk of osteoporosis compared to healthy subjects [10]. Indeed COPD has been included in the male osteoporosis risk estimation score [11]. The etiology of osteoporosis in COPD is probably complex and various factors may contribute to its pathogenesis. Some of these are consequences of the chronic inflammatory lung disease itself. Lung damage leads to dyspnoea resulting in reduced physical activity, reduced skeletal muscle mass and changes in body composition. The natural changes due to ageing like hypogonadism and inactivity may be the associated risk factors. Environmental factors and habits like smoking also contribute to the pathogenesis of osteoporosis in COPD. Corticosteroid treatment (both inhaled and systemic) therapy used during the COPD or *Corresponding author: Mradul K Daga, Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India, Tel: 09968604273, Fax: 01123222964; E-mail: [email protected] Received April 06, 2018; Accepted April 16, 2018; Published April 21, 2018 Citation: Daga MK, Bharali D, Gupta B, Mawari G, Hira HS (2018) Assessment of Osteoporosis and Osteopenia and its Co-Relation with Disease Severity in Patients of Chronic Obstructive Pulmonary Disease with Respect to Associated Risk Factors: A Case Control Study in India. J Pulm Respir Med 8: 456. doi: 10.4172/2161-105X.1000456 Copyright: © 2018 Daga MK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Volume 8 • Issue 2 • 1000456

Citation: Daga MK, Bharali D, Gupta B, Mawari G, Hira HS (2018) Assessment of Osteoporosis and Osteopenia and its Co-Relation with Disease Severity in Patients of Chronic Obstructive Pulmonary Disease with Respect to Associated Risk Factors: A Case Control Study in India. J Pulm Respir Med 8: 456. doi: 10.4172/2161-105X.1000456 Page 2 of 5

LUNG disease may also be considered as important risk factors in the development of osteoporosis. Therefore, awareness amongst health care providers and early diagnosis should trigger preventive and therapeutic measures that could avoid or reduce the consequences of osteoporosis in COPD [12]. Based on the background information this study was designed to determine the prevalence of osteoporosis in COPD patients with correlation of occurrence of osteoporosis with disease severity of chronic obstructive pulmonary disease (COPD) and also to evaluate various risk factors involved in reduced bone mineral density in patients with COPD.

Methods The study was conducted at the Department of Medicine and Department of Biochemistry, Maulana Azad Medical College, Associated Lok Nayak Hospital, and Institute of Nuclear Medicine and Allied Sciences, Delhi.

Sample size calculation Sample size was calculated using test of “two proportion method” and “Two means method”. A total of 30 chronic obstructive pulmonary disease patients and 15 unrelated healthy controls without any chronic diseases leading to osteoporosis were enrolled for the study. Healthy age and sex matched persons without any chronic diseases leading to osteoporosis were included. Patients who attended the medicine and respiratory clinic in Lok Nayak Hospital were included in the study after their individual written informed consent. All individuals were subjected to pulmonary function test and DEXA scan to stage the severity of COPD and osteoporosis respectively. Occurrence of osteoporosis and osteopenia in COPD patients was investigated. Various risk factors for COPD associated with osteoporosis such as age, sex, BMI, smoking, number of exacerbations were studied and also association of osteoporosis with severity of COPD were analyzed. Serum vitamin-D-3 levels and PTH level of all the study subjects was done and the subjects with low vitamin-D-3 and high PTH level were excluded to rule out confounding factor for osteoporosis. Patients were subjected to bone densitometry and muscle mass assessment after explaining the hazards of radiation. Bone densitometry was performed in Institute of nuclear medicine and applied sciences (INMAS), Timarpur, New Delhi. GE Healthcare Lunar Prodigy DEXA machine was used for measuring the bone density at hip and lumbar spine along with muscle mass of patients [8]. A patient’s BMD was given a T-score, which was derived by comparing it to an average score for a healthy 30-year-old of the same sex and race. The difference between the “normal young” score and the patient’s score was referred to as a standard deviation (SD) [13].

Statistical analysis The statistical analysis was done using SPSS version 23.0. The parametric data was expressed as mean ± SD and compared using student t test. Pearson correlation analysis was done for evaluation of statistical association. p value