Kjensli A, Mowinckel P, Ryg M S, Falch J A
Glittreklinikken, Pb 104 Aaneby, 1485 Hakadal, Norway.
Bone. 2007 Feb;40(2):493-7. doi: 10.1016/j.bone.2006.09.005. Epub 2006 Oct 13.
Chronic obstructive pulmonary disease (COPD) appears to be associated with low bone mineral density (BMD). BMD loss can be accelerated by a number of factors associated with COPD, but it is not known whether COPD itself has a direct effect. Our aim was to investigate in a cross-sectional study whether COPD patients have lower BMD than healthy individuals, and whether the severity of the disease affects BMD. Eighty-eight COPD patients attending a rehabilitation program were classified into stages II, III and IV using GOLD criteria. BMD was measured by dual X-ray absorptiometry in lumbar spine (L2-4), femoral neck (FN) and total body (TB). Values were converted to Z-scores (adjusted for age and sex). Associations between Z-scores and steroid use, body mass index, pack-years and six-min walking distance were analyzed. The Z-scores (mean and (CI)) for all patients were for L2-4: -0.6 (-0.9, -0.3), FN: -0.8 (-1.0, -0.5) and TB: -0.5 (-0.8, -0.2). All scores were significantly different from those of a control population (p<0.001). For all three variables (ZL2-4, ZFN, ZTB) there were significant differences between the stages. The difference for ZL2-4 was still significant after adjustment for risk factors. We conclude that BMD is low in COPD patients and decreases with increasing severity of the disease. Low BMD may to some extent be a disease-specific effect.
慢性阻塞性肺疾病（COPD）似乎与低骨矿物质密度（BMD）相关。与COPD相关的一些因素可加速骨密度丧失，但尚不清楚COPD本身是否具有直接影响。我们的目的是在一项横断面研究中调查COPD患者的骨密度是否低于健康个体，以及疾病的严重程度是否会影响骨密度。88名参加康复计划的COPD患者根据GOLD标准分为II、III和IV期。采用双能X线吸收法测量腰椎（L2-4）、股骨颈（FN）和全身（TB）的骨密度。将数值转换为Z评分（根据年龄和性别进行调整）。分析了Z评分与类固醇使用、体重指数、吸烟包年数和6分钟步行距离之间的关联。所有患者的Z评分（均值和（CI））在L2-4为：-0.6（-0.9，-0.3），FN为：-0.8（-1.0，-0.5），TB为：-0.5（-0.8，-0.2）。所有评分均与对照组有显著差异（p<0.001）。对于所有三个变量（ZL2-4、ZFN、ZTB），各阶段之间存在显著差异。在对危险因素进行调整后，ZL2-4的差异仍然显著。我们得出结论，COPD患者的骨密度较低，且随疾病严重程度的增加而降低。低骨密度在一定程度上可能是疾病特异性效应。
