|
| Initial evaluation |
| (i) Detailed medical history and physical examination |
| (ii) Documentation of height, weight, and BMI |
| (iii) Assessment of COPD severity |
| (iv) Definition of major risk factors associated with low BMD and fractures |
| (v) Exclusion or treatment of other secondary causes of bone loss in men |
| (vi) Assessment of serum 25-OHD. Additional laboratories tests, as suggested by results of clinical evaluation |
| (vii) Confirmation with lateral spinal radiography of possible vertebral fracture in patients with back pain, height loss, or kyphosis |
|
| BMD measurement with DEXA |
| (i) Recommendations: |
| All COPD men with 3 minor (BMI < 21 kg/m2, current smoking, use of ethanol >3 units/day, age > 65 years, parent hip fracture, rib fracture, inactivity, FEV1 < 50% predicted) or 1 major [systemic corticosteroids (3 months/year), major fragility fracture (spine-hip)] |
| (ii) Sites: hip and lumbar spine |
| (iii) Diagnostic categories of BMD according to WHO: definition of osteopenia (low bone mass) as BMD T-score between −1.0 and −2.5 SD and definition of osteoporosis as BMD T-score ≤−2.5 SD |
| (iv) Measurement interval: |
| (1) 2 years or more to follow loss or treatment effect |
| (2) 1 year if use of OGCSs without antiresorptive therapy |
|
| Fracture risk estimation |
| (i) Fracture risk assessment tool (FRAX), is a useful supplement to BMD assessments, as it helps physicians to decide which patients might require prolonged treatment to reduce the risk of future fractures |
|
| Prevention and treatment of osteoporosis |
| (i) Lifestyle measures and nutritional recommendations |
| (1) Smoking cessation or avoidance. |
| (2) Reduction of alcohol consumption, if excessive |
| (3) Weight-bearing and strengthening exercise |
| (4) Counselling on fall prevention |
| (5) Rehabilitation programs in moderate to severe COPD |
| (6) Calcium and vitamin D supplementation (1000 mg and 800 IU, respectively) to everyone COPD man |
| (ii) Management of COPD treatment based on the use of limited CS doses. |
| (ii) Drug therapy |
| (1) Bisphosphonates |
| (2) Anabolic drugs (teriparatide) |
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