Mechanism of Normocytic Anemia, Osteoporosis, and Diabetes in COPD

[LichenPlanus]

Can anyone clarify why Normocytic Anemia, Osteoporosis, and Diabetes commonly occur secondary to COPD?

From gathering my knowledge from resources I've studied so far, COPD causes chronic inflammation:

• Anemia: shouldn't it be like Fe deficency anemia? Or is it normocytic since not severe enough?
• Osteoporosis: ischemia, catabolic state if inflammation continuous?
• Diabetes: ischemia?

Anyone have any insight? Thanks

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[syoung]

chronic inflammation locks iron away so you'd get normocytic anemia, you're not losing blood or iron truly
i think there's a similar mechanism by which DM develops
osteoporosis, not really sure; may be because COPDers are less mobile and exercise less -> faster bone loss

 

[Jabbed]

Can anyone clarify why Normocytic Anemia, Osteoporosis, and Diabetes commonly occur secondary to COPD?

From gathering my knowledge from resources I've studied so far, COPD causes chronic inflammation:

• Anemia: shouldn't it be like Fe deficency anemia? Or is it normocytic since not severe enough?
• Osteoporosis: ischemia, catabolic state if inflammation continuous?
• Diabetes: ischemia?

Anyone have any insight? Thanks

The anemia of COPD is an example of the ubiquitous 'anemia of chronic disease' which is related to the effect of hepcidin on macrophages inducing a low serum iron state. This is classically normocytic, although it can be microcytic.

Osteoporosis is related to the chronic inflammatory state associated with COPD. Recall that IL-1 is also known as osteoclast stimulating factor.

I'm not aware of the effect that COPD has on predisposing to or affecting diabetes status. I would venture a guess that long term steroid therapy for COPD contributes to the hyperglycemic state.

 

[pd1112]

IL-6 and TNF-a have bone resorptive properties as well. TNF-a phosphorylates Ser/Thr residues on the insulin receptor, which prevents the signaling cascade -> insulin resistance.