Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk

Jaramillo, Joshua D.; Wilson, Carla; Stinson, Douglas; Lynch, David A.; Bowler, Russell P.; Lutz, Sharon M.; Bon, Jessica; Arnold, Ben; McDonald, Merry-Lynn; Washko, George R.; Wan, Emily S.; DeMeo, Dawn L.; Foreman, Marilyn G.; Soler, Xavier; Lindsay, Sarah E.; Lane, Nancy E.; Genant, Harry K.; Silverman, Edwin K.; Hokanson, John E.; Make, Barry J.; Crapo, James D.; Regan, Elizabeth A.

doi:10.1513/annalsats.201412-591oc

Cited by 106 publications

(112 citation statements)

References 39 publications

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“…The prevalence of VFs in our study population (21.6% of the COPD subjects had !1 VF at baseline and 33.5% at 3-year followup) was at the somewhat lower range compared with prevalence of most COPD reports found in literature (mostly 24% to 45%, (23)(24)(25)(26)(27)(28)(29)(30)32) with outliers of 9.0% (15) and 79.4% (31) ). This could probably be explained by the fact that the subjects in this study were not using oral GC at baseline because of study design (subjects using oral GC at baseline were excluded, and only 23 and 47 subjects, respectively, reported oral GC use at 1-year and 3-year follow-up), whereas in most (12% to 86% (15,(25)(26)(27)(29)(30)(31)(32) GC use) but not all (2.2% to 4.5% (23,24,28) GC use) studies, the percentage of subjects using GCs was considerably higher.…”

Section: Comparison To Published Researchcontrasting

confidence: 53%

“…This could probably be explained by the fact that the subjects in this study were not using oral GC at baseline because of study design (subjects using oral GC at baseline were excluded, and only 23 and 47 subjects, respectively, reported oral GC use at 1-year and 3-year follow-up), whereas in most (12% to 86% (15,(25)(26)(27)(29)(30)(31)(32) GC use) but not all (2.2% to 4.5% (23,24,28) GC use) studies, the percentage of subjects using GCs was considerably higher.…”

Section: Comparison To Published Researchmentioning

confidence: 95%

“…(12,18,22) The prevalence of radiographic VFs in subjects with COPD as reported in the literature is varying between 9.0% and 79%, (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) with the prevalence of radiographic VFs in subjects with COPD increasing from 32% to 52% in a 3-year time period. (32) However, the incidence of clinical VFs in subjects with COPD was as low as 1.3/1000 person-years (35) to 6% over 2.6 years (36) and 0.5% to 1.0% within 3 years.…”

Section: Introductionmentioning

confidence: 99%

“…(32) However, the incidence of clinical VFs in subjects with COPD was as low as 1.3/1000 person-years (35) to 6% over 2.6 years (36) and 0.5% to 1.0% within 3 years. (37) Smokers without COPD have lower BMD, (38) an increased risk of VFs, (11,24,34,38,39) and an increased risk of any osteoporotic fracture. (10,39) The prevalence of radiographic VFs in smokers as reported in the literature varied between 11% and 24%, (34,38) whereas incidence of clinical VFs varied from 3% (40) (30-year follow-up) to 26% (39) (10-year follow-up).…”

Section: Introductionmentioning

confidence: 99%

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High Imminent Vertebral Fracture Risk in Subjects With COPD With a Prevalent or Incident Vertebral Fracture

Dort

Geusens

Driessen

et al. 2018

Journal of Bone and Mineral Research

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Subjects with chronic obstructive pulmonary disease (COPD) have an increased risk of vertebral fractures (VFs); however, VF incidence is largely unknown. Therefore, the aim of our study was to determine the incidence of new and/or worsening VF in subjects with COPD. Smokers and subjects with COPD (GOLD II-IV) from the ECLIPSE study with complete set of chest CT scans (baseline and 1-and 3-year follow-up) to evaluate vertebrae T 1 down to L 1 were included. If a VF was diagnosed on the last scan, detailed VF assessment of the previous scans was performed. VFs were scored according to the method of Genant as mild, moderate, or severe. Main outcome measure was the cumulative incidence of new and/or worsening VF at subject level, within 1 and 3 years. Of 1239 subjects (mean age 61 years, 757 males [61%], 999 subjects with COPD), 253 (20.5%) had !1 prevalent VF. The cumulative incidence of VFs was 10.1% within 1 year and 24.0% within 3 years. After adjustment for age, sex, body mass index (BMI), pack-years, and smoking status, prevalence and incidence were similar between smokers and COPD GOLD stages. Within 1 year, 29.2% of the subjects with a prevalent VF had an incident VF, compared with 5.1% in absence of prevalent VF (hazard ratio [HR] ¼ 5.1; 95% confidence interval [CI] 3.6-7.4) and 58.5% versus 15.0% within 3 years (HR ¼ 3.6; 95% CI 2.9-4.6). The incidence of VF was higher with increasing number and severity of prevalent VFs. Among subjects having an incident VF within the first year, 57.3% had a subsequent VF within the next 2 years. In this study, more than half of the smokers and subjects with COPD with a prevalent VF or an incident VF within the first year sustained a subsequent VF within 3 years. The 3-year risk was even higher in the presence of multiple or severe prevalent VFs.

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Section: Comparison To Published Researchcontrasting

confidence: 53%

Section: Comparison To Published Researchmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

High Imminent Vertebral Fracture Risk in Subjects With COPD With a Prevalent or Incident Vertebral Fracture

Dort

Geusens

Driessen

et al. 2018

Journal of Bone and Mineral Research

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“…More than 4 cm difference between height at age 25 and current height has been associated with vertebral fractures in several studies [19,29]. Current smoking may be an important risk factor [30], with men and those who have developed Chronic Obstructive Pulmonary Disease (COPD) being at particular risk of vertebral fractures [31]. How strongly these 'traditional' risk factors predict the presence of vertebral fracture in someone with back pain is not fully understood, although there is some evidence that in the presence of back pain increasing age, prior fracture and use of corticosteroids are still associated with the presence of vertebral fracture [11], whereas maternal hip fracture is not [11].…”

Section: Who To Image? Features In the History (See Box 1)mentioning

confidence: 99%

Spinal radiographs in those with back pain—when are they appropriate to diagnose vertebral fractures?

2017

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms The presence of an osteoporotic vertebral fracture improves fracture risk assessment and may change management, so it is vital for healthcare professionals to assess patients for the presence or absence of these fractures. This may be particularly important in the presence of back pain. However, the correlation between low back symptoms and spinal imaging results is poor and the pathophysiology of most low back pain is not known, leading to a common conclusion that spinal radiographs are not appropriate for the assessment of back pain. For individual patients with back pain, spinal radiographs should be considered if they have certain features in the history and examination. As well as the traditional risk factors for osteoporosis, self-reported descriptives of back pain and novel physical examination findings have been shown to make the presence of vertebral fractures more likely. Systematic approaches have the potential to improve bone health across the population, but need to be targeted to be cost-effective. KeywordsVertebral fracture Back pain Pain descriptives Physical examinationMini Abstract (50 words)Spinal radiographs should be considered for individual older patients with back pain if they have certain additional features in the history and examination.

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Bone Health

2017

Public Health Nutrition 2nd Edition

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Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk

Cited by 106 publications

References 39 publications

High Imminent Vertebral Fracture Risk in Subjects With COPD With a Prevalent or Incident Vertebral Fracture

High Imminent Vertebral Fracture Risk in Subjects With COPD With a Prevalent or Incident Vertebral Fracture

Spinal radiographs in those with back pain—when are they appropriate to diagnose vertebral fractures?

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