Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
COPD. 2012 Aug;9(4):332-7. doi: 10.3109/15412555.2012.667850. Epub 2012 Apr 11.
Bone mineral density (BMD) alone does not reliably predict osteoporotic fractures. The Fracture Risk Assessment Tool (FRAX) was developed to estimate the risk of fracture in the general population. This study was designed to identify predictors of osteoporosis and vertebral fractures in patients presenting with chronic obstructive pulmonary disease (COPD). We studied 85 patients (mean age = 75 years; 92% men) with moderate to very severe COPD. Osteoporosis and vertebral fractures were diagnosed with dual energy X-ray absorptiometric scan and vertebral X-rays, respectively. Patient characteristics, including age, gender, body mass index (BMI), and results of pulmonary function tests, chest computed tomography scan, blood and urinary biomarkers of bone turnover were recorded, and a FRAX score was calculated by a computer-based algorithm. Osteoporosis, defined as a T score < -2.5, found in 20 patients (24%), was associated with female gender, BMI, dyspnea scale, long-term oxygen therapy (LTOT), vital capacity (VC), emphysema score on computed tomography, measurements of serum and urinary biomarkers of bone turnover. Vertebral fractures, diagnosed in 29 patients (35%), were strongly correlated with age, LTOT, VC, and forced expiratory volume in 1 sec, treatment with oral corticosteroid or warfarin, and weakly associated with the presence of osteoporosis. There was no correlation between FRAX score and prevalence of vertebral fractures, suggesting that neither BMD alone nor FRAX score would predict the presence of vertebral fractures in COPD patients. A disease-specific algorithm to predict osteoporotic fractures is needed to improve the management of patients suffering from COPD.
骨密度（BMD）单独不能可靠地预测骨质疏松性骨折。骨折风险评估工具（FRAX）的开发是为了估计普通人群骨折的风险。本研究旨在确定慢性阻塞性肺疾病（COPD）患者中骨质疏松症和椎体骨折的预测因素。我们研究了 85 名（平均年龄=75 岁；92%为男性）中至重度 COPD 患者。骨质疏松症和椎体骨折分别通过双能 X 射线吸收法和椎体 X 射线诊断。记录了患者特征，包括年龄、性别、体重指数（BMI）和肺功能检查、胸部计算机断层扫描、血液和尿液骨转换生物标志物的结果，并通过计算机算法计算 FRAX 评分。骨质疏松症定义为 T 评分< -2.5，20 名患者（24%）存在骨质疏松症，与女性、BMI、呼吸困难量表、长期氧疗（LTOT）、肺活量（VC）、计算机断层扫描肺气肿评分、血清和尿液骨转换生物标志物测量有关。29 名患者（35%）诊断出椎体骨折，与年龄、LTOT、VC 和 1 秒用力呼气量、口服皮质类固醇或华法林治疗强烈相关，与骨质疏松症的存在弱相关。FRAX 评分与椎体骨折的患病率之间没有相关性，表明无论是 BMD 还是 FRAX 评分都不能预测 COPD 患者的椎体骨折。需要一种针对特定疾病的算法来预测骨质疏松性骨折，以改善患有 COPD 的患者的管理。
