Журнал «Боль. Суставы. Позвоночник» 2 (18) 2015

Статья опубликована на с. 91-92

Introduction. The pathogenesis of osteoporosis in patients with chronic obstructive diseases of lungs (COPD) is associated with pathophysiological features of the disease, exactly with the development of systemic inflammation.

The aim of this study is devoted to studying a problem of bone metabolism as one of systemic manifestations of COPD, the role of endogenous intoxication, systemic inflammation, general adaptation syndrome as major predictors of disease progression and their impact on clinical course and quality of life of patients.

Materials and methods. A comprehensive clinical examination and the study of structural and functional condition of the bone tissue and calcium–phosphorus homeostasis were performed in 696 COPD patients.

Results. The investigation of systemic inflammation markers in COPD patients made possible to predict a development of systemic effects of the disease and to establish early diagnosis of an imbalance in bone metabolism, which may lead to the development and progression of osteoporosis. We suggested using some indices of bone metabolism (osteocalcin, vitamin D, b–terminal telopeptides), blood serum cytokine profile (IL–1a, TNF–b), and endogenous intoxication markers (middle–molecular peptides, fibrinogen) as diagnostic criteria of systemic disorders of bone metabolism in COPD patients.

Results. It was revealed that with increasing severity of disease and patient’s age COPD inflammation activity increases with increasing levels of markers of systemic inflammation. It has been determined significant inverse correlations between markers of systemic inflammation and bone formation, and direct correlations between markers of bone resorption, which confirm the adverse effect of active inflammation in the metabolic processes in the bone tissue. It has been determined significant (p < 0.05) negative correlation between COPD stage and axial skeleton BMD of the lumbar spine (r = –0.80), radius (r = –0.73), femur (r = –0.75), all skeletal sites (r = –0.73); trunk (r = –0.71); pelvis (r = –0.71); limbs (r = –0.62).

We determined the frequency of osteopenic syndrome, osteoporosis and osteoporotic fractures in COPD patients according to age, sex, severity and duration of illness. Risk factors of osteoporosis for patients with chronic obstructive pulmonary disease were also determined. A lumbar spine was found the most vulnerable area for osteoporosis in COPD patients, as evidenced by a significant decrease of bone mineral density in this area in patients with at least stage II of the disease.

The study established the relationship of bone metabolism with bad habits of patients, severity of COPD, age, systemic inflammation, and formation of negative adaptive responses.

We found new aspects of pathogenesis of osteoporosis in COPD patients. Hypoxia and acidosis, chronic inflammation and hyperinflation, frequent exacerbations, accompanied with intoxication syndrome, stress reactions of nonspecific resistance of organism, vitamin D deficiency/insufficiency, deterioration of microcirculation and nutritional status were found disturbances arising from development of systemic inflammation syndrome and drivers of osteo–deficiency conditions in COPD patients.

Conclusions. We developed an algorithm of COPD patients’ supervision that served as a basis for reducing a period of diagnostic process and definition of ultimate risk group in terms of development of systemic osteoporosis and its complications. The particular attention should be paid to such osteoporosis risk factors as severity of bronchial obstruction, low BMI values, smoking experience and age of COPD patients as the most important ones.