seminar 09-04-2014 osteoporose bij copd
DESCRIPTION
Osteoporose bij COPDTRANSCRIPT
Osteoporose bij COPD
Lise%e Romme Catharina ziekenhuis
9 april 2014
mw. L. Romme
Disclosures
GlaxoSmithKline Nederland
mw. L. Romme
COPD
“A common preventable and treatable disease which is characterised by persistent airflow limitaHon that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious parHcles or gases. ExacerbaHons and comorbidiHes contribute to the overall severity in individual paHents.”
www.goldcopd.org
mw. L. Romme
COPD
“A common preventable and treatable disease which is characterised by persistent airflow limitaHon that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious parHcles or gases. ExacerbaHons and comorbidi4es contribute to the overall severity in individual pa4ents.”
www.goldcopd.org
mw. L. Romme
Co-‐morbiditeiten (1)
0
5
10
15
20
25
30
35
COPD
Smokers
Non-‐‑smokers
% deelnem
ers
*** +
***
+
++
+
Miller et al. Respir Med 2013
mw. L. Romme
Co-‐morbiditeiten (2)
-‐‑5
0
5
10
15
20
25
30
35
40
45
COPD
Smokers
Non-smokers% deelnem
ers
***
**
* **
+
Miller et al. Respir Med 2013
mw. L. Romme
Epidemiologie
Prevalen4e osteoporose Meta-‐analyse. ERJ 2009: 35% (9-‐69%)
Prevalen4e wervelfracturen NuH et al. Osteoporos Int 2009 (n=3030): 40% Ogura-‐Tomomatsu et al. COPD 2012 (n=85): 35%
mw. L. Romme
Risicofactoren
• LuchtwegobstrucHe • Emfyseem • Veroudering • Lage body mass index • Lage vet vrije massa index • Vitamine D deficiënHe
• Orale en inhalaHecorHcosteroïden • Lichamelijke acHviteit • Roken en alcoholgebruik
Romme et al. ERM 2013
mw. L. Romme
Inflammatoire ziekten
Bai et al. Respir Res 2011 Hardy & Cooper. J Endocrinol 2009
mw. L. Romme
Systemische inflamma4e
Barnes & Celli. ERJ 2009
Acute fase eiwiNen CRP
Serum amyloid A SP-‐D
Perifere ontsteking in de longen
Myocard-‐ infarct Hargalen Osteoporose
Diabetes Metabool syndroom
Anemie Depressie
“Spill-‐over”
Systemische inflamma4e
IL-‐6, IL-‐1β, TNF-‐α
Spierzwakte Cachexie
mw. L. Romme
Lehouck et al. Chest 2011
COPD en osteoporose
mw. L. Romme
Complexiteit Socio-‐economic determinants
Gender Genes
Lifestyle-‐environment Risk and protecHve factors, tobacco smoking, pollutants, allergens, nutriHon, infecHons,
physical exercise, others
Biological expression of chronic diseases Transcripts, proteins, metabolites, Target organ local inflammaHon,
Systemic inflammaHon Cell and Hssue remodeling
Clinical expression of chronic diseases Co-‐morbidiHes, Severity of co-‐morbidiHes,
Persistence remission Long-‐term morbidity,
Responsiveness -‐ side effects to treatment
Age
Bousquet et al. Genome Med 2011
mw. L. Romme
Fenotypering
Weinig co-morbiditeiten (31%)
Cardiovasculair (23%)
Cachectisch (21%)
Psychologisch (9%)
Metabool (16%)
Vanfleteren et al. Am J Respir Crit Care Med 2013
mw. L. Romme
Weinig comorbidi-‐
teiten
Cardio-‐vasculair Cachec4sch Metabool Psycho-‐
logisch
n 67 49 44 33 20 Aantal comorbiditeiten 2,5 ± 1,4 3,8 ± 1,7 4,2 ± 1,4 4,4 ± 1,1 4,1 ± 1,8
Nierfunc4e-‐stoornis, % 16 24 45 9 5
Anemie, % 9 4 2 3 5 Hypertensie, % 3 98 43 100 5 Obesitas, % 30 14 0 61 15 Ondergewicht, % 0 0 66 3 0 Spierzwakte, % 12 10 98 0 20 Hyperglycemie, % 52 14 43 91 60 Dyslipidemie, % 42 16 25 67 40 Osteoporose, % 27 37 52 0 35 Angst, % 5 28 26 0 84 Depressie, % 6 23 7 6 68 Atherosclerose, % 56 67 12 81 53
Myocardinfarct, % 2 11 7 13 32
Vanfleteren et al. Am J Respir Crit Care Med 2013
mw. L. Romme
“Integrated imaging”
Mets et al. JAMA 2012
mw. L. Romme
“Integrated imaging”
Mets et al. JAMA 2012
Botdichtheid??? mw. L. Romme
“Bone aNenua4on”
Botdichtheid DEXA (g/cm2)
Botdichthe
id CT (Hou
nsfie
ld Units)
r=0,83 en p<0,001
Romme et al. JBMR 2012
mw. L. Romme
Conclusies
• COPD wordt gekenmerkt door pulmonale verschijnselen en co-‐morbiditeiten.
• Ongeveer 35% van de COPD paHënten heep osteoporose.
• De klinische expressie van COPD wordt door vele factoren (genen, leepijd, leefsHjl) beïnvloed.
• Het fenotyperen van COPD paHënten en “integrated imaging” zouden kunnen bijdragen aan meer inzicht in de complexiteit van COPD. mw. L. R
omme