Low bone mineral density is related to severity of chronic obstructive pulmonary disease
Introduction
Chronic obstructive pulmonary disease (COPD) appears to be associated with low bone mineral density (BMD) [1], [2], [3], [4], [5] and a higher risk of fractures [4], [6], [7], [8], [9]. In these patients there is a high prevalence of factors known to contribute to BMD loss, like smoking [10], inactivity [11], nutritional impairment [12], corticosteroid use [8], [9], [13] and changes in acid base balance caused by hypercapnia [14] or hypoxia [15]. When correcting for the influence of these factors, there are few data available for determining whether the disease itself has an effect on BMD loss.
In the present cross-sectional study, our aim was to find out whether BMD was lower in a randomly selected group of COPD patients than in a healthy reference population. Secondly, we wished to explore whether the severity of COPD had an impact on BMD, and thirdly, to what extent reduced BMD was associated with the disease itself or with known risk factors for osteoporosis that are often present in patients with COPD.
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Subjects
A total of 142 subjects were randomly selected from a population of 363 consecutively admitted COPD patients attending a 4 week rehabilitation program at Glittreklinikken, Norway, in 1998 (weeks 37–50) and 1999 (weeks 18–24 and 34–48). The clinic offers rehabilitation programs for lung patients with various diagnoses and disease severity, who are referred from all over the country.
The diagnosis was based on previous clinical history and on FEV1 < 80% and FEV1/FVC < 70% [16]. Spirometry measurements
Results
The total number of 363 COPD patients admitted to the clinic in the period, consisted of 186 men and 177 women. The randomly selected group of 142 patients consisted of 86 men and 56 women; of these 41 were excluded (Table 1) and 13 declined the invitation. This resulted in a study group of 88 patients, 57 men and 31 women.
Age and FEV1 did not differ between the study group and the total patient group. However, the proportion of men was significantly higher in the study group (Table 2), owing
Discussion
We found that BMD was significantly lower in COPD patients than in a healthy reference population and that it decreased with increasing severity of COPD. Even after adjusting for variables known to be risk factors for osteoporosis, there were significant differences in ZL2–4 for patients in stage IV compared with those in stages II and III, indicating a disease-specific effect of COPD on lumbar BMD. Bolton et al. also found an association between BMD loss and severity of lung disease [23].
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