Climate change, environmental pollution, and virus epidemics have sharply increased the number of patients suffering from
respiratory diseases in recent years. Prolonged periods of illness and
drug use increase the occurrence of complications in these patients.
Osteoporosis is the common bone metabolism disease with respiratory disturbance, which affects prognosis and increases mortality of patients. The problem of
osteoporosis in patients with
respiratory diseases needs more attention. In this review, we concluded the characteristics of
osteoporosis in some
respiratory diseases including
COPD,
asthma,
COVID-19,
tuberculosis, and
lung cancer. We revealed that
hypoxia was the common pathogenesis of
osteoporosis secondary to
respiratory diseases, with
malnutrition and
corticosteroid abuse driving the progression of
osteoporosis.
Hypoxia-induced ROS accumulation and activated HIF-1α lead to attenuated osteogenesis and enhanced osteoclastogenesis in patients with
respiratory diseases.
Tuberculosis and
cancer also invaded bone tissue and reduced bone strength by direct infiltration. For the treatment of
osteoporosis in respiratory patients, oral-optimized
bisphosphonates were the best treatment modality.
Vitamin D was a necessary supplement, both for
calcium absorption in osteogenesis and for improvement of respiratory lesions. Reasonable adjustment of the dose and course of
corticosteroids according to the etiology and condition of patients is beneficial to prevent the occurrence and development of
osteoporosis. Additionally, HIF-1α was a potential target for the treatment of
osteoporosis in respiratory patients, which could be activated under
hypoxia condition and involved in the process of bone remodeling.