FeNO, systemic inflammation and other risk factors for osteoporosis in COPD

Year 2023, Volume: 6 Issue: 1, 122 - 127, 12.01.2023

Ömür Güngör , A. Füsun Kalpaklıoğlu

https://doi.org/10.32322/jhsm.1212043

Abstract

Aim: The bone is one of the tissues that is adversely affected as a result of inflammation in COPD. The aim of this study is to examine the relationship between airway inflammation, systemic inflammation and osteoporosis in COPD.
Material and Method: A cross-sectional study was performed, including 50 patients with stable COPD. FeNO as a marker of airway inflammation; hs-CRP, WBC and fibrinogen as systemic inflammation markers; arterial blood gas, BMI and FEV1 were measured. To identify osteoporosis, DEXA was performed.
Results: The prevalence of osteoporosis was 26%. Osteoporosis was associated with WBC and hs-CRP (OR: 1.80, 95% CI, 1.26-2.57 and OR: 2.32, 95% CI, 1.28-4.20, respectively). It was observed that the risk increased as FEV1 and BMI decreased (OR: 0.94, 95% CI, 0.89-0.98 and OR: 0.75, 95% CI, 0.61-0.91, respectively). There was no relationship between osteoporosis and FeNO and fibrinogen (OR: 1.05, 95% CI, 0.99-1.12 and OR: 1.04, 95% CI 0.98-1.09, respectively). Arterial blood gases (PaO2 and PaCO2) were not effective on osteoporosis (OR: 1.01, 95% CI, 0.95-1.05 and OR: 1.04, 95% CI, 0.90-1.19, respectively). The cut-off values of hs-CRP and WBC for osteoporosis risk were 15.9 mg/L and 11.6 ×10⁹/L, respectively.
Conclusions: Osteoporosis was associated with low BMI, airway stenosis and high levels of hs-CRP and WBC.

Keywords

COPD, inflammation, osteoporosis, FeNO, arterial blood gas

References

• Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2021 report) 2020. (updated 2020 Nov 25); (cited 2021 December 3). Available from: https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf.
• Stanojkovic I, Kotur-Stevuljevic J, Spasic S, et al. Relationship between bone resorption, oxidative stress and inflammation in severe COPD exacerbation. Clin Biochem 2013; 46: 1678-82.
• Agusti A, Edwards LD, Rennard SI, et al. Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators. Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype. PloS one 2012; 7: e37483.
• Duvoix A, Dickens J, Haq I, et al. Blood fibrinogen as a biomarker of chronic obstructive pulmonary disease. Thorax 2013; 68: 670-6.
• Fröhlich M, Imhof A, Berg G, et al. Association between C-reactive protein and features of the metabolic syndrome: a population-based study. Diabetes care 2000; 23: 1835-9.
• Agarwal R, Zaheer MS, Ahmad Z, Akhtar J. The relationship between C-reactive protein and prognostic factors in chronic obstructive pulmonary disease. Multidiscip Respir Med 2013; 8: 1-5.
• Agusti AGN, Villaverde JM, Togores B, Bosch M. Serial measurements of exhaled nitric oxide during exacerbations of chronic obstructive pulmonary disease. Eur Respir J 1999; 14: 523-8.
• Kharitonov SA, Robbins RA, Yates D, Keatings V, Barnes PJ. Acute and chronic effects of cigarette smoking on exhaled nitric oxide. Am J Respir Crit Care Med 1995; 152: 609-612.
• Weinstein MC, Fineberg HV. Clinical decision analysis. Philadelphia: WB Saunders; 1980.
• Romme EA, Smeenk FW, Rutten EP, Wouters EF. Osteoporosis in chronic obstructive pulmonary disease. Expert Rev Respir Med 2013; 7: 397-410.
• Biskobing DM. COPD and osteoporosis. Chest.2002; 121: 609-20.
• Bon J, Fuhrman CR, Weissfeld JL, et al. Radiographic emphysema predicts low bone mineral density in a tobacco-exposed cohort. Am J Respir Crit Care Med 2011; 183: 885-90.
• Bolton CE, Cannings-John R, Edwards PH, et al. What community measurements can be used to predict bone disease in patients with COPD? Respir Med 2007; 102: 651-7.
• Santus P, Rizzi M, Radovanovic D, et al. Psoriasis and respiratory comorbidities: the added value of fraction of exhaled nitric oxide as a new method to detect, evaluate, and monitor psoriatic systemic involvement and therapeutic efficacy. Biomed Res Int 2018; 2018: 3140682.
• Malerba M, Radaeli A, Olivini A, et al. Exhaled nitric oxide as a biomarker in COPD and related comorbidities. Biomed Res Int 2014; 2014: 271918
• Lacativa PG, Farias ML. Osteoporosis and inflammation. Arq Bras Endocrinol Metabol 2010; 54: 123-32.
• Lane NE. Therapy insight: osteoporosis and osteonecrosis in systemic lupus erythematosus. Nat Clin Pract Rheumatol 2006; 2: 562-9.
• Baykal H, Bulcun E. Relationship of clinical parameters and inflammation markers with pulmonary hypertension in patients with stable chronic obstructive pulmonary disease. Sağlık Bilimlerinde Değer 2022; 12: 6-14.
• Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009; 33: 1165-85.
• Rittayamai N, Chuaychoo B, Sriwijitkamol A. Prevalence of osteoporosis and osteopenia in Thai COPD patients. J Med Assoc Thai 2012; 95: 1021-7.
• Lin CH, Chen KH, Chen CM, Chang CH, Huang TJ, Lin CH. Risk factors for osteoporosis in male patients with chronic obstructive pulmonary disease in Taiwan. PeerJ 2018; 6: e4232.
• Lin CH, Chen KH, Chen CM, Chang CH, Huang TJ, Lin CH. Risk factors for osteoporosis in male patients with chronic obstructive pulmonary disease in Taiwan. PeerJ 2018; 6: e4232.
• Miller J, Edwards, LD, Agustí A, et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med 2013; 107: 1376-84.
• Romme EA, Murchison JT, Edwards LD, et al. CT‐measured bone attenuation in patients with chronic obstructive pulmonary disease: Relation to clinical features and outcomes. J Bone Miner Res 2013; 28: 1369-77.
• Karadag F, Cildag O, Yurekli Y, Gurgey O. Should COPD patients be routinely evaluated for bone mineral density? J Bone Miner Metab 2003; 21: 242-6.