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Pulmonology

  • Reiner Bartl
  • Christoph Bartl
Chapter

Abstract

Patients with long-standing cortisone-dependent asthma bronchiale should be regularly monitored for prevention of osteoporosis. Patients with cystic fibrosis may have osteoporosis even before lung transplantation, and this should be treated in advance. One of the systemic manifestations of chronic obstructive pulmonary disease (COPD) is skeletal muscle dysfunction, which is one factor in the development of osteopaenia/osteoporosis in these patients.

Keywords

Public health Skeletal muscle Chronic obstructive pulmonary disease Cystic fibrosis General practice 

Patients with long-standing cortisone-dependent asthma bronchiale should be regularly monitored for prevention of osteoporosis. Patients with cystic fibrosis may have osteoporosis even before lung transplantation, and this should be treated in advance. One of the systemic manifestations of chronic obstructive pulmonary disease (COPD) is skeletal muscle dysfunction, which is one factor in the development of osteopenia/osteoporosis in these patients.

Hypertrophic osteoarthropathy occurs in patients with chronic lung diseases and bronchogenic carcinoma and consists of clubbing of the digits of the hands and feet, enlargement of the extremities secondary to periosteal bone deposition and painful, swollen joints.

Pulmonary insufficiency is a major problem in patients with osteogenesis imperfecta (OI) and severe scoliosis. Up to 60% of the patients with OI have significant chest wall deformities. Progression of these deformities increases the development of restrictive pulmonary disease.

Up to 61% of patients with end-stage pulmonary disease have osteoporosis. Chronic glucocorticoid use, low BMI, vitamin D deficiency, immobility and decreased pulmonary function are all associated with a low BMD.

Patients who undergo lung transplantation have predisposing factors for low bone mass prior to transplantation:
  • Tobacco exposure

  • Chronic hypoxaemia

  • Immobility

  • Glucocorticoid use

  • Certain underlying disorders such as cystic fibrosis

The prevalence of osteoporosis varies between 55% and 66% at the spine and up to 78% for the hip. The prevalence of vertebral fracture before transplantation varies between 25% and 29%. Similar to other transplanted organs, a high turnover state has been reported after lung transplantation.

A meta-analysis showed that treatment with a bisphosphonate and vitamin D during the 1st year after solid organ transplantation was associated with a 50% reduction in the number of patients with fractures. So, modern intravenous bisphosphonates are the most promising approach for prevention and treatment of transplantation osteoporosis.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Reiner Bartl
    • 1
  • Christoph Bartl
    • 1
    • 2
  1. 1.Osteoporosis and Bone CenterMunichGermany
  2. 2.Center of Orthopaedics and Sports MedicineMunichGermany

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