Skeletal microstructural abnormalities in postmenopausal women with chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is associated with osteoporosis and fragility fractures. The objectives of this study were to assess static and dynamic indices of cancellous and cortical bone structure in postmenopausal women with COPD. Twenty women with COPD who had not received chronic oral glucocorticoids underwent bone biopsies after double tetracycline labeling. Biopsies were analyzed by histomorphometry and µCT and compared with age-matched controls. Distribution of the patients according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was: Type I (15%), Type II (40%), Type III (30%), and Type IV (15%). Mean (±SD) cancellous bone volume (15.20 ± 5.91 versus 21.34 ± 5.53%, p = .01), trabecular number (1.31 ± 0.26 versus 1.77 ± 0.51/mm, p = .003), and trabecular thickness (141 ± 23 versus 174 ± 36 µm, p = .006) were lower in patients than in controls. Connectivity density was lower in COPD (5.56 ± 2.78 versus 7.94 ± 3.08/mm, p = .04), and correlated negatively with smoking (r = -0.67; p = .0005). Trabecular separation (785 ± 183 versus 614 ± 36 µm, p = .01) and cortical porosity (4.11 ± 1.02 versus 2.32 ± 0.94 voids/mm(2); p < .0001) were higher in COPD while cortical width (458 ± 214 versus 762 ± 240 µm; p < .0001) was lower. Dynamic parameters showed significantly lower mineral apposition rate in COPD (0.56 ± 0.16 versus 0.66 ± 0.12 µm/day; p = .01). Patients with more severe disease, GOLD III and IV, presented lower bone formation rate than GOLD I and II (0.028 ± 0.009 versus 0.016+ 0.011 µm(3)/µm(2)/day; p = 04). This is the first evaluation of bone microstructure and remodeling in COPD. The skeletal abnormalities seen in cancellous and cortical bone provide an explanation for the high prevalence of vertebral fractures in this disease.
Kulak
Carolina A M
CA
Endocrine Division SEMPR, Department of Internal Medicine, Clinical Hospital of the Federal University of Parana, Curitiba, Brazil. kulakjc@gmail.com
Borba
Victoria C
VC
Jorgetti
Vanda
V
Dos Reis
Luciene M
LM
Liu
Xiaowei S
XS
Kimmel
Donald B
DB
Kulak
Jaime
J
Rabelo
Leda M
LM
Zhou
Hua
H
Guo
X Edward
XE
Bilezikian
John P
JP
Boguszewski
Cesar L
CL
Dempster
David W
DW
D000280:Administration, Inhalation; D000368:Aged; D001706:Biopsy; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D029424:Pulmonary Disease, Chronic Obstructive / Q000473:pathology*; D014057:Tomography, X-Ray Computed
D005938:Glucocorticoids