Sunday, December 23, 2012

COPD and Osteoporosis

Chronic obstructive pulmonary disease (COPD) is a disease of the lungs primarily caused by cigarette smoking. Years of exposure to free-radical-producing tobacco smoke initiates a chronic inflammatory response in the lungs that leads to a breakdown of cellular tissue and increased mucus secretion. This makes it difficult to breath and can shorten an individual's life by 7 to 10 years.

Unfortunately, the damage from smoking cigarettes does not stop there. Smoking, and the inflammation of COPD, also causes systemic problems such as muscle weakness and atrophy, arterial stiffness and cardiovascular disease, and bone loss. In fact, more than 50% of patients with COPD have osteoporosis and a high risk for fracture. Graat-Verboom et al. (2012) suggest that "screening for osteoporosis should be performed even in moderate COPD patients."

There are three major reasons for this close relationship:

   1.  Vitamin D insufficiency is common in patients with COPD.
   2.  Compromised lung capacity reduces the ability to exercise which is important for
        stimulating bone growth and for maintaining muscle strength to prevent falling.
   3.  The inflammatory response within the lungs of patients with COPD does not remain
         local but instead leads to oxidative stress and a constant outpouring of
         proinflammatory cytokines into the rest of the body, which in turn causes chronic
         systemic inflammation.

        Chronic systemic inflammation, the primary driving force behind the development of
        osteoporosis, leads to reduced hormone function such as estrogen and calcitonin
        (important for blood calcium regulation), lower calcium absorption, increased cortisol
        levels, poor blood supply to bone, and death to the bone-building osteoblast cells.

Both COPD and osteoporosis are catabolic processes in that they are the result of a whole-body destructive process. Both of these chronic diseases are fueled by the destructive effects of oxidative stress and chronic systemic inflammation. Common signs of a catabolic physiology are: low body mass index (BMI), low IGF-1 (the most powerful bone and muscle building growth factor in the body*), and muscle wasting (sarcopenia)...all of which are often seen in individuals with COPD and those with osteoporosis.

Although more than half of patients with COPD have osteoporosis, neither a DXA exam, which measures bone mineral density, or FRAX scores** are useful for predicting fractures in patients with COPD (Ogura-Tomomatsu et al., 2012). So no matter what your bone density reading is, if you have COPD, you are likely at greater risk for fracture.

Considering the fact that every thoracic vertebral compression fracture reduces the amount of air a person can take in and breath out by up to 9%, improving bone health in patients with COPD is truly a matter of life or death. So, what can be done for people with COPD and osteoporosis besides smoking cessation and osteoporosis-specific medications? Lots!

  • Have your doctor check your vitamin D level. Strive for blood levels of 50 to 60 ng/ml. Many providers suggest taking 2,000 to 4,000 IU/day of vitamin D3.
  • Have your doctor check your hsCRP. This is a protein released by your liver in response to inflammation. It will probably be high if you have COPD.
  • Eat healthy to promote an anabolic state and help tissues obtain energy for growth and cell maintenance.      
       -  Drink whey protein shakes (15 to 20 grams/day)
       -  Eat lean protein such as chicken, turkey and fish
       -  Cook with healthy oils like olive and virgin coconut
       -  Eliminate caffeinated and carbonated beverages
       -  Reduce refined carbohydrates
  • Reduce or eliminate red meat, hard cheeses, sugar, and coffee -- choices that lead to an acidic body and more inflammation.
  • Get more alkaline:
       -  Enjoy green drinks
       -  Eat LOTS of fruits and vegetables (preferably organic). I favor broccoli, kale,
          squash, prunes, apricots.....and lots more!
       -  Take advantage of OsteoMineralWhey -- a great source of alkalinizing minerals.
       -  Use OsteoSustain...a perfect calcium/magnesium/mineral complex with vitamins D
          and K.
       -  Snack on plump juicy alkaline and antioxidant rich fruit with a cup of warm
          OsteoMineralWhey. (Soak dried organic apricots and prunes in water over night.)
  • Reduce inflammation and oxidative stress.
       -  Again, eat LOTS of fruits and vegetables. In addition to being rich in alkaline
           minerals, they are high in antioxidants.
       -  Include fish oil and flax seed in your diet for their inflammation-reducing
          omega 3s.
       -  Supplement with selenium, beta-carotine, and vitamins C and E (preferably
          mixed tocopherols and tocotrienols).
       -  Coenzyme Q10 can be a great energy booster.
       -  Curcumin is very important for reducing inflammation. You can also try resveratrol,
           quercetin and boswellia serrata.
       -  There are two powerful antioxidants that can be extremely helpful for slowing the
           progression of COPD: N-acetyl cysteine (NAC) and alpha lipoic acid. These two
           anti-aging compounds help dissolve mucus, reduce inflammaiton, and aid in the
           production of glutiathion, the body's own powerful anti-oxidant.
       -  Our OsteoStim is not only great for its bone building properties but because it
           contains vitamin D, alpha lipoic acid and NAC it is a perfect fit for those with
           COPD.
       -  Take advantage of probiotics...they not only reduce inflammation and boost your
           immune system but can help prevent candida yeast infections which can be a
           problem when taking inhaled corticosteroids.
       -  Creatine monohydrate (preferably buffered) is great for building muscle and
           slowing the progression of muscle wasting that is often seen with COPD. Speaking
           of which, you can't keep your muscle tone without exercise. Of course you need to
           check with your doctor before engaging in any new exercise regime but lifting light
           weights can be extremely beneficial. As COPD progresses, so does muscle
           wasting and the risk of falling. Supplemental creatine, whey protein shakes,
           and engaging in light-weight exercises can offer significant help.
  • Now, after you have done at least some of the above for 2 to 3 months (you don't have to do it all to gain benefit but, of course, the more you do the better)...get your hsCRP tested again. It will probably be lower (indicating that you have less inflammation) and you should feel better too!

*  For more on the importance of IGF-1 for bone health and how to strive for an anabolic body. Check out pages 140 - 141 and 171 - 177 in my book, The Whole-Body Approach to Osteoporosis.

** FRAX is a diagnostic tool developed by the World Health Organization to evaluate the 10-year probability of fracture risk. This scoring system integrates various risk factors for osteoporosis (such as smoking) plus bone mineral density scores to calculate the risk of fracturing a bone in the next 10 years.

Graat-Verboom L. et al., 2012. Risk factors for osteoporosis in Caucasian patients with moderate chronic obstructive pulmonary disease: a case control study. Bone 50(60):1234-9.

Ogura-Tomomatsu H. et al., 2012. Predictors of osteoporosis and vertebral fractures in patients presenting with moderate-to-severe chronic obstructive lung disease. COPD 9(4):332-7.
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