title: Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk.
abstract: BACKGROUND
  Former smoking history and chronic obstructive pulmonary disease (COPD) are potential risk factors for osteoporosis and fractures. Under existing guidelines for osteoporosis screening, women are included but men are not, and only current smoking is considered.
  
  
  OBJECTIVE
  To demonstrate the impact of COPD and smoking history on the risk of osteoporosis and vertebral fracture in men and women.
  
  
  METHODS
  Characteristics of participants with low volumetric bone mineral density (vBMD) were identified and related to COPD and other risk factors. We tested associations of sex and COPD with both vBMD and fractures adjusting for age, race, body mass index (BMI), smoking, and glucocorticoid use.
  
  
  RESULTS
  vBMD by calibrated quantitative computed tomography (QCT), visually scored vertebral fractures, and severity of lung disease were determined from chest CT scans of 3,321 current and ex-smokers in the COPDGene study. Low vBMD as a surrogate for osteoporosis was calculated from young adult normal values. Male smokers had a small but significantly greater risk of low vBMD (2.5 SD below young adult mean by calibrated QCT) and more fractures than female smokers. Low vBMD was present in 58% of all subjects, was more frequent in those with worse COPD, and rose to 84% among subjects with very severe COPD. Vertebral fractures were present in 37% of all subjects and were associated with lower vBMD at each Global Initiative for Chronic Obstructive Lung Disease stage of severity. Vertebral fractures were most common in the midthoracic region. COPD and especially emphysema were associated with both low vBMD and vertebral fractures after adjustment for steroid use, age, pack-years of smoking, current smoking, and exacerbations. Airway disease was associated with higher bone density after adjustment for other variables. Calibrated QCT identified more subjects with abnormal values than the standard dual-energy X-ray absorptiometry in a subset of subjects and correlated well with prevalent fractures.
  
  
  CONCLUSIONS
  Male smokers, with or without COPD, have a significant risk of low vBMD and vertebral fractures. COPD was associated with low vBMD after adjusting for race, sex, BMI, smoking, steroid use, exacerbations, and age. Screening for low vBMD by using QCT in men and women who are smokers will increase opportunities to identify and treat osteoporosis in this at-risk population.
authors.affiliation: 1 National Jewish Health, Denver, Colorado.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Jaramillo
authors.forename: Carla
authors.initials: C
authors.lastname: Wilson
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Stinson
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Stinson
authors.forename: David A
authors.initials: DA
authors.lastname: Lynch
authors.forename: Russell P
authors.initials: RP
authors.lastname: Bowler
authors.forename: Sharon
authors.initials: S
authors.lastname: Lutz
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Bon
authors.forename: Ben
authors.initials: B
authors.lastname: Arnold
authors.forename: Merry-Lynn N
authors.initials: ML
authors.lastname: McDonald
authors.forename: George R
authors.initials: GR
authors.lastname: Washko
authors.forename: Emily S
authors.initials: ES
authors.lastname: Wan
authors.forename: Dawn L
authors.initials: DL
authors.lastname: DeMeo
authors.forename: Marilyn G
authors.initials: MG
authors.lastname: Foreman
authors.forename: Xavier
authors.initials: X
authors.lastname: Soler
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lindsay
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Lane
authors.forename: Harry K
authors.initials: HK
authors.lastname: Genant
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Silverman
authors.forename: John E
authors.initials: JE
authors.lastname: Hokanson
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Make
authors.forename: James D
authors.initials: JD
authors.lastname: Crapo
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Regan
mesh_terms: D000328:Adult; D015519:Bone Density; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000378:metabolism; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014481:United States / Q000453:epidemiology
keywords: COPD; low bone density; quantitative computed tomography; smoking; vertebral fractures