title: Predictors of osteoporosis and vertebral fractures in patients presenting with moderate-to-severe chronic obstructive lung disease.
abstract: Bone mineral density (BMD) alone does not reliably predict osteoporotic fractures. The Fracture Risk Assessment Tool (FRAX) was developed to estimate the risk of fracture in the general population. This study was designed to identify predictors of osteoporosis and vertebral fractures in patients presenting with chronic obstructive pulmonary disease (COPD). We studied 85 patients (mean age = 75 years; 92% men) with moderate to very severe COPD. Osteoporosis and vertebral fractures were diagnosed with dual energy X-ray absorptiometric scan and vertebral X-rays, respectively. Patient characteristics, including age, gender, body mass index (BMI), and results of pulmonary function tests, chest computed tomography scan, blood and urinary biomarkers of bone turnover were recorded, and a FRAX score was calculated by a computer-based algorithm. Osteoporosis, defined as a T score < -2.5, found in 20 patients (24%), was associated with female gender, BMI, dyspnea scale, long-term oxygen therapy (LTOT), vital capacity (VC), emphysema score on computed tomography, measurements of serum and urinary biomarkers of bone turnover. Vertebral fractures, diagnosed in 29 patients (35%), were strongly correlated with age, LTOT, VC, and forced expiratory volume in 1 sec, treatment with oral corticosteroid or warfarin, and weakly associated with the presence of osteoporosis. There was no correlation between FRAX score and prevalence of vertebral fractures, suggesting that neither BMD alone nor FRAX score would predict the presence of vertebral fractures in COPD patients. A disease-specific algorithm to predict osteoporotic fractures is needed to improve the management of patients suffering from COPD.
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ogura-Tomomatsu
authors.forename: Koichiro
authors.initials: K
authors.lastname: Asano
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Tomomatsu
authors.forename: Jun
authors.initials: J
authors.lastname: Miyata
authors.forename: Nao
authors.initials: N
authors.lastname: Ohmori
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kodama
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ueda
authors.forename: Takahisa
authors.initials: T
authors.lastname: Takihara
authors.forename: Kyuto
authors.initials: K
authors.lastname: Tanaka
authors.forename: Nobufumi
authors.initials: N
authors.lastname: Kamiishi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Koichi
authors.initials: K
authors.lastname: Fukunaga
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Oguma
authors.forename: Koichi
authors.initials: K
authors.lastname: Sayama
authors.forename: Tomoko
authors.initials: T
authors.lastname: Betsuyaku
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism
chemical_list: D015415:Biomarkers