In another study, patients with chronic lung disease were

found to have HSP inhibitor a 5-fold increased risk of hip or spine osteoporosis compared to controls; the risk increased to 9-fold if taking steroids [3]. Three cross-sectional observational studies have described an independent association between osteoporosis with poor pulmonary function (measured as forced expiratory volume in 1 second, FEV1) [12–14]. In these studies, BMD decreased approximately 0.02 g/cm2 for every 1 L per second decrease in FEV1 and had a 2.4 increased risk of osteoporosis. Fractures have been documented in 29% of COPD and 25% of cystic fibrosis patients [4]. Vestegaard and colleagues found that chronic lung diseases like COPD and emphysema were associated with a 1.2- to 1.3-fold higher risk of fractures [15]. Selleckchem Selonsertib Inhaled corticosteroids have also been associated with increased fracture risk [16, 17]. In this cohort, men with a history of COPD or asthma did not have increased annual rate of bone loss at the total hip or femoral neck, but did have a 2.6-fold increase in vertebral fractures independent of confounders. The observed associations are likely underestimated in that they were attenuated by the selective loss of older participants with lower BMD levels, more lung disease, and poorer physical function at baseline. Moreover, more men with COPD or asthma

died or did not participate at visit 2. Although, we would have expected an increased risk of vertebral and hip fractures in men taking inhaled or oral corticosteroids, the p value was not statistically significant and was likely due to the small sample size of fractures. Smoking is a well-known cause of chronic lung disease. Tucidinostat order Corticosteroids, commonly prescribed to patients with COPD or asthma, are known to reduce bone formation and increased bone resorption

[18]. Lower body Cyclin-dependent kinase 3 weight and decreased exercise capacity in COPD patients have been shown to decrease bone mineral content and lean body mass [19]. Decreased muscle strength from physical inactivity can also accelerate respiratory decline and negatively affect BMD. In this study, corticosteroids and smoking appeared to mediate most of the observed associations and additional adjustments for possible confounders did not attenuate the observed results. We hypothesized that corticosteroids, smoking, physical inactivity, low body weight, and/or malnutrition would have explained the lower BMD and higher rates of osteoporosis in patients with obstructive pulmonary disease. It is unclear why men with COPD or asthma would have lower BMD at the total spine and hip independent of these confounders. Increased levels of systemic inflammation may be a potential mechanism to explain how pulmonary disease may affect bone. Several studies have demonstrated that individuals with chronic airflow limitation have significantly elevated levels of C-reactive protein, fibrinogen, leucocytes, and tumor necrosis factor alpha [20].