title: Smokers with emphysema and small airway disease on computed tomography have lower bone density.
abstract: Osteoporosis is more common in patients with COPD and in smokers. The aim of this study was to assess whether measures of emphysema and airway disease on computed tomography (CT) were associated with lower bone density or vertebral fractures in smokers with and without COPD. For this purpose, we included participants from the NELSON lung cancer screening trial. Bone density was measured as Hounsfield Units in the first lumbar vertebra, and vertebral fractures were assessed semiquantitatively. The 15th percentile method (Perc15) was used to assess emphysema, and the airway lumen perimeter (Pi10) was used for airway wall thickness. Expiratory/inspiratory-ratiomean lung density (E/I-ratioMLD) was used as a measure for air trapping and tracheal index to assess tracheal deformity. Linear regression models and logistic regression models were used to assess associations between CT biomarkers, bone density, and presence of fractures. Exactly 1,093 male participants were eligible for analysis. Lower Perc15 and higher E/I-ratioMLD were significantly associated with lower bone density (b=-1.27, P=0.02 and b=-0.37, P=0.02, respectively). Pi10 and tracheal index were not associated with bone density changes. CT-derived biomarkers were not associated with fracture prevalence. Bone density is lower with increasing extent of emphysema and small airway disease but is not associated with large airway disease and tracheal deformity. This may indicate the necessity to measure bone density early in smokers with emphysema and air trapping to prevent vertebral fractures.
authors.affiliation: Department of Pulmonology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Pompe
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
authors.affiliation: Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Eva M
authors.initials: EM
authors.lastname: van Rikxoort
authors.affiliation: Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Leticia
authors.initials: L
authors.lastname: Gallardo Estrella
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Werner U
authors.initials: WU
authors.lastname: de Jong
authors.affiliation: Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.affiliation: Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Carlijn M
authors.initials: CM
authors.lastname: van der Aalst
authors.affiliation: Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Bram
authors.initials: B
authors.lastname: van Ginneken
authors.affiliation: Department of Pulmonology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Lammers
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Firdaus Aa
authors.initials: FA
authors.lastname: Mohamed Hoesein
mesh_terms: D000368:Aged; D001530:Belgium; D015519:Bone Density; D018450:Disease Progression; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
keywords: COPD; air trapping; bone density; computed tomography; emphysema; phenotyping