Endocrine Division SEMPR, Department of Internal Medicine, Clinical Hospital of the Federal University of Parana, Curitiba, Brazil.
J Bone Miner Res. 2010 Sep;25(9):1931-40. doi: 10.1002/jbmr.88.
Chronic obstructive pulmonary disease (COPD) is associated with osteoporosis and fragility fractures. The objectives of this study were to assess static and dynamic indices of cancellous and cortical bone structure in postmenopausal women with COPD. Twenty women with COPD who had not received chronic oral glucocorticoids underwent bone biopsies after double tetracycline labeling. Biopsies were analyzed by histomorphometry and µCT and compared with age-matched controls. Distribution of the patients according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was: Type I (15%), Type II (40%), Type III (30%), and Type IV (15%). Mean (±SD) cancellous bone volume (15.20 ± 5.91 versus 21.34 ± 5.53%, p = .01), trabecular number (1.31 ± 0.26 versus 1.77 ± 0.51/mm, p = .003), and trabecular thickness (141 ± 23 versus 174 ± 36 µm, p = .006) were lower in patients than in controls. Connectivity density was lower in COPD (5.56 ± 2.78 versus 7.94 ± 3.08/mm, p = .04), and correlated negatively with smoking (r = -0.67; p = .0005). Trabecular separation (785 ± 183 versus 614 ± 36 µm, p = .01) and cortical porosity (4.11 ± 1.02 versus 2.32 ± 0.94 voids/mm(2); p < .0001) were higher in COPD while cortical width (458 ± 214 versus 762 ± 240 µm; p < .0001) was lower. Dynamic parameters showed significantly lower mineral apposition rate in COPD (0.56 ± 0.16 versus 0.66 ± 0.12 µm/day; p = .01). Patients with more severe disease, GOLD III and IV, presented lower bone formation rate than GOLD I and II (0.028 ± 0.009 versus 0.016+ 0.011 µm(3)/µm(2)/day; p = 04). This is the first evaluation of bone microstructure and remodeling in COPD. The skeletal abnormalities seen in cancellous and cortical bone provide an explanation for the high prevalence of vertebral fractures in this disease.
慢性阻塞性肺疾病（COPD）与骨质疏松症和脆性骨折有关。本研究的目的是评估绝经后 COPD 女性的松质骨和皮质骨结构的静态和动态指标。20 名未接受慢性口服糖皮质激素治疗的 COPD 女性接受了双四环素标记后的骨活检。通过组织形态计量学和µCT 对活检进行分析，并与年龄匹配的对照组进行比较。根据全球慢性阻塞性肺疾病倡议（GOLD）对患者的分布为：I 型（15%）、II 型（40%）、III 型（30%）和 IV 型（15%）。与对照组相比，患者的平均（±SD）松质骨体积（15.20 ± 5.91 对 21.34 ± 5.53%，p = 0.01）、骨小梁数量（1.31 ± 0.26 对 1.77 ± 0.51/mm，p = 0.003）和骨小梁厚度（141 ± 23 对 174 ± 36 µm，p = 0.006）较低。COPD 患者的连通密度较低（5.56 ± 2.78 对 7.94 ± 3.08/mm，p = 0.04），与吸烟呈负相关（r = -0.67；p = 0.0005）。骨小梁分离（785 ± 183 对 614 ± 36 µm，p = 0.01）和皮质骨孔隙率（4.11 ± 1.02 对 2.32 ± 0.94 空隙/mm²；p < 0.0001）在 COPD 中较高，而皮质宽度（458 ± 214 对 762 ± 240 µm；p < 0.0001）较低。动态参数显示 COPD 患者的矿化沉积率明显较低（0.56 ± 0.16 对 0.66 ± 0.12 µm/天；p = 0.01）。疾病更严重（GOLD III 和 IV）的患者的骨形成率低于 GOLD I 和 II（0.028 ± 0.009 对 0.016+ 0.011 µm³/µm²/天；p = 0.04）。这是首次对 COPD 中的骨微结构和重塑进行评估。松质骨和皮质骨中观察到的骨骼异常为该疾病中椎体骨折的高患病率提供了解释。
