The Relationship of Bone Mineral Density in Men with Chronic Obstructive Pulmonary Disease Classified According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Combined Chronic Obstructive Pulmonary Disease (COPD) Assessment System

Abstract

Objective Osteoporosis, which is now recognized as a major comorbidity of chronic obstructive pulmonary disease (COPD), must be diagnosed by appropriate methods. The aims of this study were to clarify the relationships between bone mineral density (BMD) and COPD-related clinical variables and to explore the association of BMD with the updated Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification in men. Methods We enrolled 50 Japanese men with clinically stable COPD who underwent dual-energy X-ray absorptiometry (DEXA), pulmonary function testing, and computerized tomography (CT) and who had completed a questionnaire (COPD assessment test [CAT]). We determined the association between the T-score and other tested parameters and compared the BMD of patients in each GOLD category. Results Twenty-three of the 50 patients (46.0%) were diagnosed with osteopenia, and 7 (14.0%) were diagnosed with osteoporosis. The BMD findings were significantly correlated with the CAT score, forced expiratory volume in 1 second percentage predicted (FEV1% predicted), low attenuation volume percentage (LAV%), and percentage of cross-sectional area of small pulmonary vessels (%CSA) on CT images. Notably, the median T-score of the GOLD category D participants was significantly lower than that of the participants in each of the other categories (A [-0.98], B [-1.06], C [-1.05], and D [-2.19], p<0.05). Conclusion Reduced BMD was associated with airflow limitation, extent of radiographic findings, and a poor quality of life (QOL) in patients with COPD. The BMD of GOLD category D patients was the lowest of all of the patients evaluated, and category D patients may benefit from active intervention for osteoporosis.

Association of Bone Mineral Density with Chronic Obstructive Pulmonary Disease in Postmenopausal Women

“…The logistic regression analyses confirmed that airway obstruction categories were associated with osteopenia/OP, even after adjustment for potential confounding factors, showing that postmenopausal women with COPD may have a higher risk of osteopenia/OP. Our finding may be supported by observations by Sakurai et al 8 , who found that the prevalence of OP in male patients with COPD was significantly higher than in those without COPD, and reduced BMD was associated with airflow limitation in male patients with COPD. Similarly, a case-control study showed that COPD was associated with low BMD in the femoral neck in male patients, reporting an OR of 1.5 for OP in COPD male patients compared with controls.…”

“…Several studies have clearly indicated OP to be associated with COPD in male patients; however, to date, few studies have examined the relationship between bone mass density (BMD) and COPD in postmenopausal women, remaining a matter of debate 2,8 . The aim of this cross-sectional study was to examine the association between BMD and COPD in postmenopausal women in Northwest China.…”

Osteoporosis among patients with chronic obstructive pulmonary disease: Systematic review and meta-analysis of prevalence, severity, and therapeutic outcomes

“…Sakurai-Iesato et al [18] concluded that 46% of participants were osteopenic and 14% were osteoporotic. They found that CAT and FEV1 scores were correlated with BMD of patients with COPD.…”

The Relationship of Weight-adjusted Bone Mass Content Associated with COPD and Associated Factors

“…Osteoporosis is one of the systemic effects of COPD, though the causal relationship and molecular association between COPD and osteoporosis has yet to be established [4] . It is commonly found in COPD patients and its prevalence is higher in these patients than in healthy subjects and those with various other chronic lung diseases such as asthma, idiopathic pulmonary fibrosis, pulmonary hypertension, sarcoidosis, scleroderma or Kartagener's syndrome and bronchiectasis [7][8][9][10][11]. Osteoporosis is also more prevalent in women than in men [11] .…”

“…Routine screening and management for osteoporosis in COPD patients enables physicians to diagnose this disorder at an early phase to reduce its negative consequences. However, some studies only have found the degree of reduced bone mineral density (BMD) to be comparable to the severity of airflow limitation [7][8][9][10] , meaning that measurement of BMD might not be a good index or sensitive enough tool to determine the degree of bone loss in COPD patients. Additionally, there have been few studies conducted in Thailand regarding the prevalence of osteoporosis and osteopenia and their association with COPD severity.…”