Riesgo de fractura osteoporótica y de cadera en pacientes con enfermedad pulmonar obstructiva crónica / Risk of osteoporotic fracture and hip fracture in patients with chronic obstructive pulmonary disease

Antecedentes y objetivos. La osteoporosis es una comorbilidad frecuente en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Hemos examinado el riesgo de fractura osteoporótica mayor y el riesgo de fractura de cadera en pacientes con EPOC. Pacientes y métodos. Se trata de un estudio observacional, multicéntrico, realizado en 26 hospitales de 16 comunidades autónomas de España. Se incluyeron pacientes diagnosticados de EPOC que requirieron ingreso y que fueron admitidos en un Servicio de Medicina Interna por exacerbación de su enfermedad respiratoria. La EPOC se confirmó mediante una espirometría posbroncodilatadora en fase estable: volumen espiratorio máximo en el primer segundo (FEV1) < 80% del valor teórico y cociente (FEV1)/capacidad vital forzada < 0,7 tras la administración de un broncodilatador. La disnea se evaluó con la escala modificada del Medical Research Council (mMRC). La variable principal fue la probabilidad de fractura con la herramienta FRAX® para la población española. Resultados. Se incluyeron 392 pacientes, 347 (88%) varones, con una edad (media y desviación estándar) de 73,7 (8,9) años y un FEV1 de 1,23 l (43,3% del predicho). Sólo 37 pacientes (9,4%; 27 varones y 10 mujeres) habían sido diagnosticados previamente de osteoporosis. Un riesgo >= 20% de sufrir en los siguientes 10 años una fractura osteoporótica mayor lo presentó un 1,8% (intervalo de convianza [IC] 95%: 0,9-3,6) y un riesgo ≥ 3% de padecer una fractura de cadera lo presentó un 49,7% (IC 95%: 44,8-54,7) de los enfermos con EPOC. No se observó relación entre la probabilidad de fractura y el estadio GOLD o la escala de disnea evaluada con la escala mMRC. Conclusiones. En nuestro medio, el diagnóstico de osteoporosis en los pacientes con EPOC es poco frecuente. Sin embargo, la mitad de ellos tiene un riesgo elevado de padecer una fractura de cadera en los próximos 10 años(AU)

Aim. Osteoporosis is a frequent comorbidity in patients with chronic obstructive pulmonary disease (COPD). We have studied the risk of major osteoporotic fracture and hip fracture in patients with COPD. Patients and methods. A multicenter cross-sectional study was performed in Spain in 26 hospitals of 16 regional communities. Patients diagnosed with COPD who required admission to the Internal Medicine Service due to exacerbation of their respiratory disease were enrolled. COPD was confirmed by post-bronchodilator spirometry in stable state: maximum expiratory volume in the first second (FEV1) < 80% of the theoretical value and quotient FEV1/FVC < 0.70 and percent predicted after the administration of a bronchodilator. Dyspnea was evaluated with the modified Medical Research Council (mMRC) dyspnea scale. The principal variable was the likelihood of fracture evaluated with the FRAX® tool for the Spanish population. Results. Three hundred and ninety two patients, 347 (88%) men, with a mean (SD) age of 73.7 (8.9) years and a mean FEV1 of 1.23 liters (43.3% of predicted) were enrolled. Only 37 patients (9.4%), 27 men and 10 women had been diagnosed previously of osteoporosis. Overall, 1.8% (95% CI: 0.9-3.6) had a 10-year probability of major osteoporotic fracture >= 20% and 49.7% (95% CI: 44.8-54.7) had a probability of hip fracture ≥ 3%. No relationship was observed between the probability of fracture and GOLD stage or mMRC dyspnea scale. Conclusions. The diagnosis of osteoporosis is uncommon in our COPD patients. However, half of them have a high probability of a hip fracture in the next 10 years(AU)

[Risk of osteoporotic fracture and hip fracture in patients with chronic obstructive pulmonary disease]. / Riesgo de fractura osteoporótica y de cadera en pacientes con enfermedad pulmonar obstructiva crónica.

AIM: Osteoporosis is a frequent comorbidity in patients with chronic obstructive pulmonary disease (COPD). We have studied the risk of major osteoporotic fracture and hip fracture in patients with COPD. PATIENTS AND METHODS: A multicenter cross-sectional study was performed in Spain in 26 hospitals of 16 regional communities. Patients diagnosed with COPD who required admission to the Internal Medicine Service due to exacerbation of their respiratory disease were enrolled. COPD was confirmed by post-bronchodilator spirometry in stable state: maximum expiratory volume in the first second (FEV1) < 80% of the theoretical value and quotient FEV(1)/FVC < 0.70 and percent predicted after the administration of a bronchodilator. Dyspnea was evaluated with the modified Medical Research Council (mMRC) dyspnea scale. The principal variable was the likelihood of fracture evaluated with the FRAX® tool for the Spanish population. RESULTS: Three hundred and ninety two patients, 347 (88%) men, with a mean (SD) age of 73.7 (8.9) years and a mean FEV1 of 1.23 liters (43.3% of predicted) were enrolled. Only 37 patients (9.4%), 27 men and 10 women had been diagnosed previously of osteoporosis. Overall, 1.8% (95% CI: 0.9-3.6) had a 10-year probability of major osteoporotic fracture ≥ 20% and 49.7% (95% CI: 44.8-54.7) had a probability of hip fracture ≥ 3%. No relationship was observed between the probability of fracture and GOLD stage or mMRC dyspnea scale. CONCLUSIONS: The diagnosis of osteoporosis is uncommon in our COPD patients. However, half of them have a high probability of a hip fracture in the next 10 years.

Morir en un hospital de agudos. Análisis de la situación de últimos días / No disponible

Objetivo: conocer la semiología y el tratamiento sintomático que precede a la defunción de los pacientes de servicios médicos no oncológicos. Método: durante 11 semanas se estudiaron todas las defunciones en los Servicios Médicos exceptuando Oncología. Se recopilaron los datos clínicos de agonía mediante revisión de las historias y entrevista al equipo responsable, así como la medicación administrada. Se analizó la relación entre los signos y síntomas definitorios de agonía y la proximidad del fallecimiento. Resultados: se incluyeron 38 pacientes, 68,4% mujeres, con una edad media de 82 años (64-97), de los cuales 31 (82%) estaban ingresados en Medicina Interna. Los diagnósticos principales fueron demencia en 9 casos (24%), ictus en 7 (18%), enfermedad pulmonar obstructiva crónica en 4 (11%) e insuficiencia cardiaca en 3 (8%). Durante los cinco días anteriores al fallecimiento, 34 pacientes (89%) presentaron debilidad máxima, 33 (87%) incapacidad para la ingesta, 30 (79%) alteraciones respiratorias, 26 (68%) disminución del nivel de consciencia, 18 (47%) fiebre, 16 (42%) estertores respiratorios, 15 (39%) xerostomía, 13 (34%) mala perfusión periférica y 8 (21%) episodios de agitación. La disminución del nivel de conciencia, incapacidad para la ingesta, alteraciones respiratorias, estertores y mala perfusión periférica se relacionaron con la defunción en los 4 días siguientes. El riesgo de fallecer aumentó más de 3 veces cuando se presentaban dos o más síntomas. El 69% de los pacientes con estertores respiratorios y el 43% de los que presentaron agitación no recibió tratamiento específico. Conclusiones: la mayoría de las defunciones estudiadas fueron precedidas de un periodo de agonía, a menudo no reconocida ni tratada. Sería conveniente diseñar protocolos de actuación para los pacientes de servicios médicos no oncológicos (AU)

Objective: to know the symptoms and symptomatic treatment preceding the death of patients in medical services, except in Oncology. Method: we studied all deaths in medical services, except in Oncology, for 11 weeks. We collected the clinical data of agony by reviewing medical and nursing records, by interviewing responsible teams, and by reviewing the medication administered. The relationship between the signs and symptoms that define the proximity of agony and death was analyzed. Results: we included 38 patients (68.4% women) with a mean age of 82 (64-97); 31 (82%) of them were admitted to Internal Medicine. The primary diagnosis was dementia in 9 cases (24%), stroke in 7 (18%), chronic obstructive pulmonary disease in 4 (11%), and heart failure in 3 cases (8%). During the last five days before death. 34 patients (89%) had maximum weakness, 33 (87%) inability to ingest, 30 (79%) respiratory distress, 26 (68%) decreased level of consciousness, 18 (47 %) fever, 16 (42%) respiratory rales, 15 (39%) dry mouth, 13 (34%) poor peripheral perfusion, and 8 (21%) episodes of agitation. Decreased level of consciousness, inability to ingest, respiratory distress, rales, and poor peripheral perfusion were related to death in the next 4 days. The risk of death increased over 3 times when two or more symptoms were present. In an, 69% of patients with respiratory rales and 43% of those with agitation received no specific treatment. Conclusions: most deaths studied were preceded by a period of agony, often unrecognized and untreated. It would be designed for these patients in medical services (AU)