THE RISK OF OSTEOPOROTIC FRACTURES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH DEPRESSION.

Kochetova Ekaterina Viktorovna

The aim of this study was to assess the risk of osteoporotic fractures in patients with chronic obstructive pulmonary disease (COPD) with depression. Research methods: The study group consisted of 65 COPD patients with long-term smoking experience. Men predominated in the study group (86.15%). According to the severity of bronchial patency disorders, 38.46% of patients corresponded to an average degree of GOLD 2, 44.62% to a severe degree of GOLD 3, 17% to an extremely severe degree of GOLD 4. Based on the scores obtained on the Beck depression scale, patients were divided into 2 groups — the first group (n=20) included COPD patients without depression (0-9 points according to the Beck depression scale). The second group (n=45) included COPD patients with depression (10-63 points on the Beck scale). The assessment of the ten-year risk of osteoporotic fractures was calculated using the FRAX computer program. The risk factors for osteoporosis included in the methodology for assessing the ten-year risk of osteoporotic fractures (FRAX, 2008) were assessed in patients of the study group: age, gender, previous fractures; fracture of the femur in parents; smoking, alcohol abuse; steroid use, rheumatoid arthritis. The Charlson comorbidity index was used to assess comorbid conditions. The study of the FVD was carried out on a multimodule installation "MasterLab/Jaeger". Exercise tolerance (6MWD, m), severity of shortness of breath (mMRC scale) were studied. The CAT test (COPD Assessment Test) was used to assess well-being. Results. During the study, 37.78% of COPD patients were diagnosed with mild depression, 20% with moderate depression, 37.8% with severe depression, and 4.42% with severe depression. The level of depression on the Beck scale in COPD patients with mild and moderate depression was 14.14± 3.36 points, in the group of COPD patients with severe and severe depression 24.42± 3.96 points. In COPD patients with mild and moderate depression, the Charlson comorbidity index was 4.71±0.96 points, with severe and severe depression 4.78±1.13 points, there was no significant difference between these indicators (p>0.05). In patients with COPD with mild and moderate depression, the risk of hip fracture and the risk of major fractures under the FRAX program were 1.53 (0.8-2.1) and 6.3 (5.37-9.07), respectively. In the group of COPD patients with severe and severe depression, the risk of hip fracture and the risk of major fractures under the FRAX program were 3 (3.95-5.23) and 8.23(6.7-14.17). Conclusions. COPD patients with mild and moderate depression accounted for 57.78%, with severe and severe depression 42.22%. There was no significant difference between the comorbidity index in groups with varying degrees of depression (p>0.05). The risk of hip fracture and the risk of major fractures according to the FRAX program were highest in the group of COPD patients with severe and severe depression 3 (3.95-5.23) and 8.23 (6.7-14.17) (p<0.05).

Keywords:chronic obstructive pulmonary disease; depression; Beck depression scale; risk of osteoporotic fractures, FRAX program; Charlson comorbidity index.