Katsura Hideki, Kida Kozui
Pulmonary Division, Tokyo Metropolitan Geriatric Medical Center 35-2, Sakae-cho, Itabashi, Tokyo, Japan.
Chest. 2002 Dec;122(6):1949-55. doi: 10.1378/chest.122.6.1949.
A recent study has shown that osteoporosis and vertebral fractures are quite common in patients with advanced COPD and showed a significant relationship to the mortality of these patients. These results suggested that management of osteoporosis in advanced COPD is an important intervention. But whether patients with COPD who had never received chronic systemic corticosteroids have a high incidence of osteoporosis and whether these patients require treatment strategies to decrease osteoporotic fracture is not yet known. Furthermore, it is unclear whether there are differences in terms of the degree of osteoporosis between patients with COPD and patients with bronchial asthma.
To compare the degree of osteoporosis and bone metabolism markers between elderly women with COPD and those with bronchial asthma who had never received chronic systemic corticosteroids, and to determine the factors influencing bone metabolism in these patients.
Cross-sectional medical survey.
A total of 44 elderly female patients with COPD (n = 20) or bronchial asthma (n = 24) who had not received chronic systemic corticosteroids were enrolled (mean +/- SEM age, 74.6 +/- 1.0 years).
Total body and lumbar bone mineral density (BMD) were measured by dual-energy x-ray absorptiometry, and the data were compared between the two groups. In addition, the association between bone mass and clinical variables was determined.
When lumbar BMD was expressed as a Z score, the Z scores of patients with COPD were significantly lower than those of patients with bronchial asthma (p < 0.01). The prevalence of osteoporosis was also significantly higher in patients with COPD (50% vs 21%, p < 0.05). In patients with COPD, body mass index was positively correlated with BMD in the lumbar spine (r = 0.55, p = 0.02) and total body (r = 0.49, p = 0.03). Other clinical, biochemical, and anthropometric variables were not correlated with BMD.
In elderly female patients, osteoporosis is more common in cases of COPD than in bronchial asthma, even if these patients had not received long-term systemic corticosteroids. The explanation for the higher prevalence of osteoporosis in COPD is still not known, but preventive strategies to decrease osteoporotic fractures should be added to the management of elderly patients with COPD.
最近一项研究表明，骨质疏松症和椎体骨折在晚期慢性阻塞性肺疾病（COPD）患者中相当常见，且与这些患者的死亡率显著相关。这些结果提示，晚期COPD患者骨质疏松症的管理是一项重要干预措施。但从未接受过慢性全身糖皮质激素治疗的COPD患者骨质疏松症发病率是否较高，以及这些患者是否需要采取治疗策略以降低骨质疏松性骨折的风险尚不清楚。此外，COPD患者与支气管哮喘患者在骨质疏松程度方面是否存在差异也不明确。
比较从未接受过慢性全身糖皮质激素治疗的老年女性COPD患者和支气管哮喘患者的骨质疏松程度及骨代谢标志物，并确定影响这些患者骨代谢的因素。
横断面医学调查。
共纳入44例未接受过慢性全身糖皮质激素治疗的老年女性患者，其中COPD患者20例，支气管哮喘患者24例（平均年龄±标准误为74.6±1.0岁）。
采用双能X线吸收法测量全身和腰椎骨密度（BMD），并对两组数据进行比较。此外，确定骨量与临床变量之间的关联。
以腰椎BMD的Z值表示时，COPD患者的Z值显著低于支气管哮喘患者（p<0.01）。COPD患者骨质疏松症的患病率也显著更高（50%对21%，p<0.05）。在COPD患者中，体重指数与腰椎（r=0.55，p=0.02）和全身（r=0.49，p=0.03）的BMD呈正相关。其他临床、生化和人体测量变量与BMD均无相关性。
在老年女性患者中，即使未接受长期全身糖皮质激素治疗，COPD患者的骨质疏松症也比支气管哮喘患者更常见。COPD患者骨质疏松症患病率较高的原因尚不清楚，但在老年COPD患者的管理中应增加降低骨质疏松性骨折的预防策略。
