Elsevier

Respiratory Medicine

Volume 148, March 2019, Pages 13-23
Respiratory Medicine

Predictive and modifying factors of bone mineral density decline in patients with COPD

https://doi.org/10.1016/j.rmed.2019.01.005Get rights and content
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Highlights

  • Factors predicting and modifying rapid decline of bone mineral density in COPD patients were investigated.

  • Rapid decliners had a significantly greater rate of new vertebral fractures.

  • Age, emphysema, no daily exercise habits, and anemia increased the likelihood of rapid decliners.

  • Bisphosphonate had positive effect on BMD decline over 3 years.

Abstract

Rationale

Various determinants of osteoporosis have been previously identified. However, only a few longitudinal studies have examined related factors. We aimed to investigate factors predicting and modifying rapid decline of bone mineral density in patients with chronic obstructive pulmonary disease.

Methods

We analyzed patients with chronic obstructive pulmonary disease whose bone mineral density were measured at least three times over three years (n = 111). We divided annual per cent changes of bone mineral density in different body parts into tertiles. Rapid decliners (n = 33) were defined as those with the largest decline in at least two parts; all other participants were defined as non-rapid decliners (n = 78).

Results

At enrollment, bone mineral density did not differ between the two groups. However, rapid decliners had a significantly greater rate of new vertebral fractures over 3 years compared with non-rapid decliners. On multivariate logistic regression analysis, age, moderate to severe emphysema, no daily exercise habits, and anemia increased the likelihood of rapid decliners. Furthermore, patients who newly started and continued bisphosphonate exhibited higher annual per cent changes of bone mineral density than did those without bisphosphonate use.

Conclusions

A rapid decline in bone mineral density correlates to a higher likelihood of vertebral fracture. We clarified the predictors of bone mineral density decline and demonstrated that bisphosphonate use might modify bone mineral density in patients with chronic obstructive pulmonary disease.

Keywords

COPD
Comorbidity
Osteoporosis
Vertebral fracture
Bisphosphonate

Abbreviations

COPD
chronic obstructive pulmonary disease
QOL
quality of life
BMI
body-mass index
BMD
bone mineral density
ICS
inhaled corticosteroid
SD
standard deviation
K-CCR
Keio Chronic Obstructive Pulmonary Disease Comorbidity Research
WHO
World Health Organization
SGRQ
St. George's Respiratory Questionnaire
SF-36
Short Form 36 Health Survey
CT
computed tomography
LAA%
ratio of low attenuation are to total lung volume
DXA
Dual-energy X-ray Absorptiometry
IQR
interquartile range
GOLD
Global Initiative for Chronic Obstructive Lung Disease
OCS
oral corticosteroid
FEV1
forced expiratory volume in 1 s
%FEV1
forced expiratory volume in 1 s as a percentage of predicted value
DLCO/VA
diffusing capacity of the lung for carbon monoxide divided by alveolar volume
%DLCO/VA
diffusing capacity of the lung for carbon monoxide divided by alveolar volume as a percentage of predicted value

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