COPD is both a localized disease to the lungs and also a systemic disease which can affect many other organs of the body.  There is a generalized systemic inflammatory process, which is part of this disease, and is associated with many other problems.  Some of the co-morbidities associated with COPD include cardiovascular disease, muscle atrophy, the metabolic syndrome, and osteoporosis, to name a few.

            Osteoporosis is particularly problematic in patients with COPD because it generally has no symptoms.  The first time it may affect the patient is when a bone fracture occurs.  These osteoporosis-related fractures are associate with several adverse outcomes for COPD patients, including an increase in hospitalization and mortality rates, a decline in lung function, and a poor quality of life.  Naturally occurring osteoporosis is often fueled by the use of corticosteroids used at time of exacerbation.  It should be mentioned that the corticosteroids referred to here are oral or intravenous agents.  The inhaled steroids in commonly used inhalers have little absorption, and what is absorbed is detoxified in one pass through the liver.

            The obvious question is how do we prevent or stop advancing osteoporosis in this disease population?  The answer is not very satisfying, but maintaining an adequate diet and preventing weight loss, reducing hospitalizations which result in inactivity and often result in increased steroid use, and being as active as possible including attending a pulmonary rehabilitation program, can all be helpful in reducing the incidence and extent of osteoporosis in patients with COPD.