This document discusses osteoporosis in patients with COPD. It provides epidemiological data showing that about 35% of COPD patients have osteoporosis. It also examines the various risk factors for osteoporosis in COPD patients like low body mass index, vitamin D deficiency, use of oral corticosteroids, smoking, and physical inactivity. The document notes the complexity of COPD and how comorbidities contribute to its severity, highlighting the role of systemic inflammation in both COPD and osteoporosis. Phenotyping COPD patients and integrated imaging techniques are presented as ways to better understand this complexity.

1. Osteoporose
bij
COPD
Lise%e
Romme
Catharina
ziekenhuis
9
april
2014
mw. L. Romme

2. Disclosures
GlaxoSmithKline
Nederland
mw. L. Romme

3. COPD
“A
common
preventable
and
treatable
disease
which
is
characterised
by
persistent
airflow
limitaHon
that
is
usually
progressive
and
associated
with
an
enhanced
chronic
inflammatory
response
in
the
airways
and
the
lung
to
noxious
parHcles
or
gases.
ExacerbaHons
and
comorbidiHes
contribute
to
the
overall
severity
in
individual
paHents.”
www.goldcopd.org
mw. L. Romme

4. COPD
“A
common
preventable
and
treatable
disease
which
is
characterised
by
persistent
airflow
limitaHon
that
is
usually
progressive
and
associated
with
an
enhanced
chronic
inflammatory
response
in
the
airways
and
the
lung
to
noxious
parHcles
or
gases.
ExacerbaHons
and
comorbidi4es
contribute
to
the
overall
severity
in
individual
pa4ents.”
www.goldcopd.org
mw. L. Romme

5. Co-­‐morbiditeiten
(1)
0
5
10
15
20
25
30
35
COPD
Smokers
Non-­‐‑smokers
%
deelnemers
***
+
***
+
++
+
Miller
et
al.
Respir
Med
2013
mw. L. Romme

6. Co-­‐morbiditeiten
(2)
-­‐‑5
0
5
10
15
20
25
30
35
40
45
COPD
Smokers
Non-smokers
%
deelnemers
***
**
*
**
+
Miller
et
al.
Respir
Med
2013
mw. L. Romme

7. Epidemiologie
Prevalen4e
osteoporose
Meta-­‐analyse.
ERJ
2009:
35%
(9-­‐69%)
Prevalen4e
wervelfracturen
NuH
et
al.
Osteoporos
Int
2009
(n=3030):
40%
Ogura-­‐Tomomatsu
et
al.
COPD
2012
(n=85):
35%
mw. L. Romme

8. Risicofactoren
• LuchtwegobstrucHe
• Emfyseem
• Veroudering
• Lage
body
mass
index
• Lage
vet
vrije
massa
index
• Vitamine
D
deficiënHe
• Orale
en
inhalaHecorHcosteroïden
• Lichamelijke
acHviteit
• Roken
en
alcoholgebruik
Romme
et
al.
ERM
2013
mw. L. Romme

9. Inflammatoire
ziekten
Bai
et
al.
Respir
Res
2011
Hardy
&
Cooper.
J
Endocrinol
2009
mw. L. Romme

10. Systemische
inflamma4e
Barnes
&
Celli.
ERJ
2009
Acute
fase
eiwiNen
CRP
Serum
amyloid
A
SP-­‐D
Perifere
ontsteking
in
de
longen
Myocard-­‐
infarct
Hargalen
Osteoporose
Diabetes
Metabool
syndroom
Anemie
Depressie
“Spill-­‐over”
Systemische
inflamma4e
IL-­‐6,
IL-­‐1β,
TNF-­‐α
Spierzwakte
Cachexie
mw. L. Romme

11. Lehouck
et
al.
Chest
2011
COPD
en
osteoporose
mw. L. Romme

12. Complexiteit
Socio-­‐economic
determinants
Gender
Genes
Lifestyle-­‐environment
Risk
and
protecHve
factors,
tobacco
smoking,
pollutants,
allergens,
nutriHon,
infecHons,
physical
exercise,
others
Biological
expression
of
chronic
diseases
Transcripts,
proteins,
metabolites,
Target
organ
local
inflammaHon,
Systemic
inflammaHon
Cell
and
Hssue
remodeling
Clinical
expression
of
chronic
diseases
Co-­‐morbidiHes,
Severity
of
co-­‐morbidiHes,
Persistence
remission
Long-­‐term
morbidity,
Responsiveness
-­‐
side
effects
to
treatment
Age
Bousquet
et
al.
Genome
Med
2011
mw. L. Romme

13. Fenotypering
Weinig co-morbiditeiten (31%)
Cardiovasculair (23%)
Cachectisch
(21%)
Psychologisch (9%)
Metabool (16%)
Vanfleteren
et
al.
Am
J
Respir
Crit
Care
Med
2013
mw. L. Romme

14. Weinig
comorbidi-­‐
teiten
Cardio-­‐
vasculair
Cachec4sch
Metabool
Psycho-­‐
logisch
n
67
49
44
33
20
Aantal
comorbiditeiten
2,5
±
1,4
3,8
±
1,7
4,2
±
1,4
4,4
±
1,1
4,1
±
1,8
Nierfunc4e-­‐
stoornis,
%
16
24
45
9
5
Anemie,
%
9
4
2
3
5
Hypertensie,
%
3
98
43
100
5
Obesitas,
%
30
14
0
61
15
Ondergewicht,
%
0
0
66
3
0
Spierzwakte,
%
12
10
98
0
20
Hyperglycemie,
%
52
14
43
91
60
Dyslipidemie,
%
42
16
25
67
40
Osteoporose,
%
27
37
52
0
35
Angst,
%
5
28
26
0
84
Depressie,
%
6
23
7
6
68
Atherosclerose,
%
56
67
12
81
53
Myocardinfarct,
%
2
11
7
13
32
Vanfleteren
et
al.
Am
J
Respir
Crit
Care
Med
2013
mw. L. Romme

15. “Integrated
imaging”
Mets
et
al.
JAMA
2012
mw. L. Romme

16. “Integrated
imaging”
Mets
et
al.
JAMA
2012
Botdichtheid???
mw. L. Romme

17. “Bone
aNenua4on”
Botdichtheid
DEXA
(g/cm2)
Botdichtheid
CT
(Hounsfield
Units)
r=0,83
en
p<0,001
Romme
et
al.
JBMR
2012
mw. L. Romme

18. Conclusies
• COPD
wordt
gekenmerkt
door
pulmonale
verschijnselen
en
co-­‐morbiditeiten.
• Ongeveer
35%
van
de
COPD
paHënten
heep
osteoporose.
• De
klinische
expressie
van
COPD
wordt
door
vele
factoren
(genen,
leepijd,
leefsHjl)
beïnvloed.
• Het
fenotyperen
van
COPD
paHënten
en
“integrated
imaging”
zouden
kunnen
bijdragen
aan
meer
inzicht
in
de
complexiteit
van
COPD.
mw. L. Romme