Tuberc Respir Dis.  2012 Mar;72(3):310-317.

Association of Bone Mineral Density with Airway Obstruction and Emphysema

• Sim YS
• Lee JH
• Kim Y
• Chang JH

Abstract

BACKGROUND
Airway obstruction and the extent of emphysema are reported to be responsible for reduced bone mineral density (BMD). Corresponding to different phenotypes of a pulmonary disease, different severity in extra pulmonary features may exist. We compared BMDs of subjects with or without airway obstruction and/or emphysema and investigated the relationships among BMD, the severity of airway obstruction, and the extent of emphysema.
METHODS
Using a university hospital database, we reviewed patients over 40 years old who performed spirometry, computed tomography of chest, and measurement of BMD of the lumbar (L) spine. According to the presence or absence of airway obstruction and/or emphysema, four groups were classified.
RESULTS
Among a total of 59 subjects, 33 (56%) had osteoporosis. The prevalence of osteoporosis in subjects with no airway obstruction and no emphysema, those with only emphysema, those with only airway obstruction, and those with both airway obstruction and emphysema were 42%, 57%, 64%, and 73%, respectively (p=0.047 by linear-by-linear association). The mean T-scores of BMD of L1 (p=0.032) and L1-4 spines were different among the four groups (p=0.034). Although the T-score of L1 BMD negatively correlated with the extent of emphysema (r=-0.275, p=0.035) and positively with each of body mass index (BMI) (r=0.520, p<0.001), forced expiratory volume in one second (FEV1) (r=0.330, p=0.011), FEV1/forced vital capacity (r=0.409, p=0.001), and forced expiratory flow at 25~75% of FVC (FEF(25-75%)) (r=0.438, p=0.0001), respectively, multiple linear regression analysis indicated that BMI (p<0.001) and FEF(25-75%) were predictive of BMD (p=0.012).
CONCLUSION
Low BMI and airway obstruction were strongly associated with reduced bone density rather than the extent of emphysema.

Keyword

Airway Obstruction; Bone Density; Pulmonary Emphysema; Osteoporosis; Body Mass Index

MeSH Terms

Airway Obstruction
Body Mass Index
Bone Density
Emphysema
Forced Expiratory Volume
Humans
Linear Models
Lung Diseases
Osteoporosis
Phenotype
Prevalence
Pulmonary Emphysema
Spine
Spirometry
Thorax
Vital Capacity

Figure

• 

  Figure 1 Four groups of patients disclosed by the presence or absence of airway obstruction and/or emphysema. Group 1 (n=26) with no airway obstruction (AO) and no emphysema are presented as hollow circles; group 2 (n=7) with emphysema and no AO, full circles; group 3 (n=11) with AO and no emphysema, hollow triangles; and group 4 (n=15) with both AO and emphysema, full triangles.

• 

  Figure 2 Association between the presence of reduced bone mineral density (BMD) and four groups. The prevalence of reduced BMD, including osteopenia and osteoporosis, and osteoporosis in the four groups were: 65%, 86%, 91%, and 93% (p=0.021 linear-by-linear association) and 42%, 57%, 64%, and 73% (p=0.047 linear-by-linear association), respectively.

• 

  Figure 3 (A, B) T-scores of L1 and L1~4 in four groups. CI: confidence interval.

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