Male Veterans with COPD At High Risk of Bone Disease

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By Annette M. Boyle

LOMA LINDA, CA – A pair of new studies shows a very high prevalence of bone disease among male veterans with chronic obstructive pulmonary disease (COPD) and other pulmonary illnesses, raising the question of whether more screening is needed.

In the first study, presented at the American Thoracic Society International Conference, nearly 60% of 46 veterans referred to a pulmonary clinic at the VA Loma Linda Healthcare System in Loma Linda, CA, had positive dual-emission X-ray absorptiometry (DXA) scans. Of the 27 patients with bone disease, 78% had osteopenia (21), and 22% (6) had osteoporosis. Forty-five of the patients were male.1

Retired Sgt. 1st Class Jay Stephens (left) and retired Senior Master Sgt. Vince Carr participate in the Chronic Obstructive Pulmonary Disease rehabilitation maintenance program at Wilford Hall Medical Center in 2011. The program is designed to help patients improve their quality of life through oxygen and exercise therapy. — U.S. Air Force photo/Tech. Sgt. Andy Bellamy

Of the patients referred to the pulmonary rehabilitation clinic, 80% had diagnoses of COPD, 16% had idiopathic pulmonary fibrosis, and 4% had asthma. The researchers noted that those patients with more severe lung disease also were more likely to have osteoporosis or osteopenia.

For the VA, understanding this correlation between pulmonary disease and bone disease could have widespread implications. “COPD has bypassed stroke to become the third-leading cause of death in the U.S. and fifth most prevalent disease in the veteran population, affecting approximately 15% of VA healthcare users,” according to Christine Freeman, PhD, research biologist at VA Medical Center, Ann Arbor, MI, and research investigator in Internal Medicine at the University of Michigan Health System.

The VA currently routinely screens female veterans over the age of 65 for osteoporosis but recommends men for bone assessments only on a case-by-case basis.

“The high prevalence of bone disease we found in male patients referred to our pulmonary rehabilitation program suggests that routine screening should also be performed in men with pulmonary disease,” said lead investigator Kathleen Ellstrom, PhD, RN, APRN-BC, Pulmonary Clinical Nurse Specialist and Director of the Pulmonary Rehabilitation Program at the Veterans Administration Loma Linda Healthcare System.

National guidelines do not yet recommend such screening. “The VA follows the guidelines issued by the U.S. Preventive Task Force, and there is not a national screening program for osteoporosis in COPD,” said a VA spokesperson. “A review in UpToDate published this January also does not recommend routine screening for osteoporosis in men.”

However, national guidelines do “suggest screening in men for those with radiographic osteopenia, history of low trauma fractures and loss of more than 1.5 inches in height, as well as in those with risk factors for fracture, such as long-term glucocorticoid therapy and androgen deprivation therapy for prostate,” the VA spokesperson told U.S. Medicine.

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