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. 2017;56(14):1781-1790.
doi: 10.2169/internalmedicine.56.6910. Epub 2017 Jul 15.

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

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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

Yoriko Sakurai-Iesato et al. Intern Med. .
Free PMC article

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.

Keywords: COPD assessment test (CAT); bone mineral density (BMD); combined COPD assessment system; dual-energy X-ray absorptiometry (DEXA).

Figures

Figure 1.
Figure 1.
Association between BMD T-scores and ICS. The difference in the T-scores between ICS users and nonusers was not significant (-1.70 SD vs. -1.14 SD, p=0.052). BMD: bone mineral density, ICS: inhaled corticosteroid, SD: standard deviations
Figure 2.
Figure 2.
Correlations between BMD T-scores and CAT. There was a significant negative correlation between the T-scores and (a) CAT scores (r=-0.31, p=0.03). Among 8 questions, scores for (b) ‘chest tightness,’ (c) ‘breathlessness,’ and (d) ‘confidence in leaving home’ were significantly correlated with T-scores (r=-0.32, p=0.02, r=-0.36, p=0.01, and r=-0.37, p<0.01, respectively). BMD: bone mineral density, CAT: chronic obstructive pulmonary disease assessment test, SD: standard deviations
Figure 3.
Figure 3.
Correlations between BMD T-scores and other parameters. The T-scores were significantly positively correlated with (a) BMI values (r=0.37, p<0.01), (b) FEV1% predicted values (r=0.51, p<0.001), and (d) %CSA<5 values (r=0.36, p<0.01). A significant negative correlation was found between T-scores and (c) LAV% values (r=-0.34, p=0.02). BMD: bone mineral density, BMI: body mass index, FEV1% predicted, percentage of forced expiratory volume in one second predicted value, LAV%: percentage of low attenuation volume, %CSA<5: percentage of cross-sectional area of small pulmonary vessels less than 5 mm2, SD: standard deviations
Figure 4.
Figure 4.
BMD T-scores and the GOLD combined COPD assessment system. The T-scores of category D patients were significantly lower than the scores of category A, B, and C patients (p<0.05). BMD: bone mineral density, GOLD: Global Initiative for Chronic Obstructive Lung Disease, COPD: chronic obstructive pulmonary disease, SD: standard deviations

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