Avaliação da prevalência de osteoporose, parâmetros de fragilidade óssea e fatores de risco associados na doença pulmonar obstrutiva crônica

• Ano de defesa: 2020
• Autor(a) principal: Okuma, Mariana Gomes Adas [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Chronic Obstructive Pulmonary Disease (COPD); Osteoporosis; Osteoporose; Fragilidade Óssea; Doença Pulmonar Obstrutiva Crônica - DPOC
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9968158; https://hdl.handle.net/11600/64760

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition that imposes a considerable burden for the population worldwide. Chronic complications related to COPD are not restricted to the lungs and may affect several extrapulmonary systems. Osteoporosis is one of the most neglected complications of COPD, imposing a higher risk of fractures and increased morbidity and mortality. Objectives: To assess, in a case-control study, the prevalence of fractures due to frailty and osteoporosis assessed by densitometry (DXA), in addition to identifying the risk factors of these conditions in individuals with COPD. Materials and Methods: The study included individuals with COPD (COPD group; COPDG) undergoing clinical follow-up at a tertiary outpatient clinic in an academic hospital, and age- and sex-matched controls without COPD (control group; CG). Measurements of the spine and femoral bone mineral density (BMD) were obtained from all individuals by DXA. Osteoporosis was diagnosed at a T score ≤ - 2.5. Total fractures were assessed from the patients' clinical history and thoracic and lumbar spine radiographs. Blood was collected for measurement of markers of bone remodeling (CTX and P1NP) and serum levels of parathyroid hormone and 25-hydroxyvitamin D (25OHD). All patients underwent pulmonary function test. Different statistical tests were used to compare the data, and p values ≤ 0.05 were considered significant. Results: Overall, 91 individuals were included in the COPDG (60.1% men, age 66.2±9.2 years) and 81 individuals in the CG (58% men, age 64.1±8.9 years). The prevalence of total fractures in the COPDG was 57.1%, and the risk of fracture in this group was 4.7-fold greater than that in the CG, with the femoral neck BMD emerging as the best predictor of total fractures. The COPDG, compared with the CG, presented a higher prevalence of fractures associated with falls (36.3% vs. 7.4%, respectively, p<0.01), osteoporosis (29.7% vs. 17.3%, respectively, p<0.01), and lower BMD in the three sites analyzed (L1-L4 1.050±0.190 vs. 1.130±0.230, respectively, p=0.01; femoral neck 0.860±0.130 vs. 0.960±0.180, respectively, p<0.01; and total femur 0.920±0.140 vs. 1.030±0.180, respectively, p<0.01). Vertebral fractures were more prevalent in men with COPD compared with controls (24% vs. 6.5%, respectively, p=0.02). The COPDG, in relation to the CG, presented a 2.6-fold higher risk of osteoporosis and lower levels of CTX (0.322±0.170 ng/mL vs. 0.378±0.190 ng/mL, respectively, p=0.04) and 25(OH)D (24.04 ng/mL vs. 28.8 ng/mL, respectively, p=0.01). In the CG, the risk of fractures increased with femoral neck T- score values ≤ -2.7, while in the COPDG, this risk was significantly increased at T- score values ≤ -0.6. Conclusions: Individuals with COPD have about a two-fold greater risk of osteoporosis and almost a five-fold greater risk of fractures than individuals without COPD, a difference that was more evident in male patients. Even though the femoral neck T score was the best predictor of fractures, the fractures in the COPDG occurred at higher BMD values than expected, showing that the pulmonary disease is an independent marker of fracture risk.