Bolton C E, Cannings-John R, Edwards P H, Ionescu A A, Evans W D, Pettit R J, Faulkner T A, Stone M D, Shale D J
Department of Respiratory Medicine, School of Medicine, Cardiff University, Academic Centre, Llandough Hospital, Penarth, Penlan Road, Vale of Glamorgan, CF64 2XX, UK.
Respir Med. 2008 May;102(5):651-7. doi: 10.1016/j.rmed.2007.12.027. Epub 2008 Mar 4.
Osteoporosis is common in patients with COPD. Previously we have reported that loss of fat-free mass (FFM), measured by dual X-ray absorptiometry (DXA) is associated with loss of bone mineral density (BMD). In addition, in patients with a low body mass index (BMI) and a low FFM, all had evidence of bone thinning, 50% having osteopenia and 50% osteoporosis. We explored the utility of different anthropometric measures in detecting osteoporosis in a community-based COPD population.
Patients with confirmed COPD and not on long-term oral corticosteroids (n=58) performed spirometry. They underwent nutritional assessment by skinfold anthropometry, midarm circumference, calculation of both % ideal body weight (IBW) and BMI. All had DXA assessment of BMD.
A total of 58 COPD patients had anthropometric measurements taken, with a mean age of 66.8 (SD 8.7) years, 31 (58%) were male, with a forced expiratory volume in 1s (FEV(1)) of 54.17 (20.18)% predicted. Osteoporosis was present at either the hip or lumbar region in 14 patients (24%). The useful anthropometric measurements identifying those with osteoporosis were both % IBW and BMI. The adjusted odds ratio for %IBW was 0.93 (95% confidence interval (CI) 0.87, 0.99), p=0.016 and for BMI: 0.79 (0.64-0.98), p=0.03. The receiver operating characteristics (ROC) score for both was 0.88, indicating a good fit.
Osteoporosis is common, even in patients with mild airways obstruction. Nutritional assessment, incorporating a calculation of their BMI or %IBW may confer an additional benefit in detecting those at risk of osteoporosis and guide referral for BMD measurement.
骨质疏松在慢性阻塞性肺疾病（COPD）患者中很常见。此前我们曾报道，通过双能X线吸收法（DXA）测量的去脂体重（FFM）丢失与骨矿物质密度（BMD）丢失相关。此外，在体重指数（BMI）低且FFM低的患者中，所有人都有骨质变薄的迹象，50%患有骨质减少，50%患有骨质疏松。我们探讨了不同人体测量指标在以社区为基础的COPD人群中检测骨质疏松的效用。
确诊为COPD且未使用长期口服糖皮质激素的患者（n = 58）进行了肺功能测定。他们通过皮褶人体测量、上臂中部周长、计算理想体重百分比（IBW）和BMI进行了营养评估。所有人都进行了BMD 的DXA评估。
共有58例COPD患者进行了人体测量，平均年龄为66.8（标准差8.7）岁，31例（58%）为男性，1秒用力呼气容积（FEV(1)）为预测值的54.17（20.18）%。14例患者（24%）在髋部或腰椎区域存在骨质疏松症。识别出患有骨质疏松症患者的有用人体测量指标是IBW百分比和BMI。IBW百分比的调整比值比为0.93（95%置信区间（CI）0.87，0.99），p = 0.016，BMI的调整比值比为0.79（0.64 - 0.98），p = 0.03。两者的受试者工作特征（ROC）评分均为0.88，表明拟合良好。
骨质疏松很常见，即使在轻度气道阻塞的患者中也是如此。纳入BMI或IBW百分比计算的营养评估可能在检测有骨质疏松风险的患者方面带来额外益处，并指导进行BMD测量的转诊。
