Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Bone. 2012 Jun;50(6):1234-9. doi: 10.1016/j.bone.2012.02.638. Epub 2012 Mar 9.
The prevalence of osteoporosis is high in chronic obstructive pulmonary disease (COPD) patients. The gold standard for the diagnosis of osteoporosis is bone mineral density (BMD) measurements as assessed by dual energy absorptiometry (DXA) scanning as well as vertebral fractures as assessed by instant vertebral assessment (IVA). The aim of this study was to compare COPD GOLD II patients (that is, patients with moderate COPD, stage II, according to the GOLD classification) with osteoporosis (cases) to COPD GOLD II patients without osteoporosis (controls) to identify risk factors for osteoporosis. The diagnosis of osteoporosis was based on BMD and vertebral fractures. Cases (n=49) were matched for gender, age and forced expiratory volume in the first second to controls (n=49). We assessed pulmonary function, body composition, vitamin D, emphysema score (by high-resolution computer tomography), medical history and medication use in all patients. Variables that were significantly different between the cases and controls were included in a logistic regression analysis. COPD patients with osteoporosis had a significantly lower body mass index (BMI) and higher residual volume as the percentage of total lung capacity (RV%TLC) compared to COPD patients without osteoporosis. Decreasing BMI and increasing RV%TLC increased the odds ratio for osteoporosis. Overweight and obese BMI values were protective for osteoporosis. Screening for osteoporosis should be performed even in moderate COPD patients, especially in those with a low BMI and/or a high RV%TLC.
慢性阻塞性肺疾病（COPD）患者骨质疏松症的患病率很高。骨质疏松症的金标准诊断是通过双能吸收法（DXA）扫描评估的骨矿物质密度（BMD）测量，以及通过即时椎体评估（IVA）评估的椎体骨折。本研究的目的是比较 COPD GOLD II 患者（即根据 GOLD 分类，中度 COPD，II 期）与骨质疏松症（病例）和没有骨质疏松症的 COPD GOLD II 患者（对照），以确定骨质疏松症的危险因素。骨质疏松症的诊断基于 BMD 和椎体骨折。根据性别、年龄和第一秒用力呼气量（FEV1），将病例（n=49）与对照组（n=49）匹配。我们评估了所有患者的肺功能、身体成分、维生素 D、肺气肿评分（通过高分辨率计算机断层扫描）、病史和药物使用情况。病例和对照组之间有显著差异的变量被纳入逻辑回归分析。与没有骨质疏松症的 COPD 患者相比，患有骨质疏松症的 COPD 患者的体重指数（BMI）明显较低，残气量占肺总量的百分比（RV%TLC）较高。BMI 降低和 RV%TLC 增加都会增加骨质疏松症的比值比。超重和肥胖 BMI 值对骨质疏松症有保护作用。即使在中度 COPD 患者中，也应该进行骨质疏松症筛查，特别是在 BMI 较低和/或 RV%TLC 较高的患者中。
