Assessment of osteoprotegerin and receptor activator of nf-kb ligand in malaysian male patients with chronic obstructive pulmonary disease: a cross-sectional study

Ahmad N. Bitar, Department of Clinical Pharmacy, Faculty of Pharmacy, University Sultan Zainal Abidin, Terengganu, Malaysia
Majed A. Al-Mansoub, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Malaysia Sarawak University, Sarawak, Malaysia
Syed A. Syed-Sulaiman, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
Fadi G. Saqallah, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
Irfhan A.B. Hyder-Ali, Respiratory Department, Penang General Hospital, Penang, Malaysia
Salah A. Alshehade, Department of Pharmacology, Faculty of Pharmacy and Biomedical Sciences, MAHSA University, Selangor, Malaysia
Amer Hayat-Khan, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia

Background: Limited information exists regarding the pathophysiological interactions between osteoporosis and chronic obstructive pulmonary disease (COPD). Objective: To study the association of Osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-Β ligand (RANKL) in male COPD patients. Methods: An observational clinical study was conducted at Penang General Hospital in Malaysia. Participants were divided into three groups: COPD patients with osteoporosis, COPD patients without osteoporosis, and healthy participants of the same age groups. Serum OPG (sOPG) and RANKL (sRANKL) levels were investigated. Results: The mean age of COPD patients was 64.10 ± 10.04 years. COPD patients had lower body mass index (23.22 ± 6.43) than healthy participants (27.32 ± 6.80). The T-score was significantly lower among COPD patients than healthy participants (p = 0.018). The sOPG concentration among healthy participants was significantly higher (361.90 ± 29.10 pg/mL, p < 0.001) than in the other groups, while the sRANKL concentration was not significantly different. The serum OPG/RANKL concentration was markedly higher in the control group than in the COPD patient group (p < 0.05). The COPD patients with osteoporosis had significantly lower pulmonary parameters (forced expiratory volume in the first [FEV]1% and FEV1/[forced vital capacity] (FVC), p < 0.01) and more dyspnea (modified medical research council = 2.60 ± 0.78 versus 1.90 ± 0.70, p < 0.01) than did the patients without osteoporosis. Furthermore, patients with severe COPD had a 3 times greater risk of developing osteoporosis (OR = 2.997 [95% CI = 2.181, 4.118], p < 0.001), while spirometric parameters had a significant inverse relationship with osteoporosis (FEV1% OR = 0.970, [95% CI = 0.954, 0.986], p = 0.001; FEV1/FVC OR = 0.984, (95% CI = 0.970, 0.999], p = 0.035). Conclusion: The study concluded that COPD patients had lower sOPG levels, leading to decreased OPG/RANKL ratio and faster bone resorption. Low bone mineral density was associated with more severe COPD.