Yamamoto Yoshifumi, Yoshikawa Masanori, Tomoda Koichi, Fujita Yukio, Yamauchi Motoo, Fukuoka Atsuhiko, Tamaki Shinji, Koyama Noriko, Kimura Hiroshi
Second Department of Internal Medicine, Nara Medical University, Nara, Japan.
Respiration. 2014;87(2):158-64. doi: 10.1159/000355095. Epub 2013 Dec 7.
Although low bone mineral density is highly prevalent in patients with chronic obstructive pulmonary disease (COPD), the distribution of the reduced bone mass has not been fully elucidated.
To determine regional bone mass loss in patients with COPD and investigate whether the change in distribution may be associated with body weight loss and functional capacity.
Body mass index (BMI) was assessed, and height squared indices were derived for the bone mineral content index (BMCI) of the arms, legs and trunk by dual-energy X-ray absorptiometry in 45 male patients with COPD and 12 age- and sex-matched control subjects. Pulmonary function tests were performed, and maximal oxygen uptake (VO2max) was measured.
The BMCI was lower in the total bone, legs and trunk of patients with COPD than in control subjects, although the BMCI in the arms was similar between the groups. BMI correlated significantly with the BMCI in all 3 segments. Bone mineral content (BMC) in the trunk, expressed as a percentage of total BMC (BMC trunk/total BMC), correlated significantly with BMI. The BMCI in the trunk was closely related with VO2max but not with airflow limitation.
There was a regional difference in BMC reduction, but a predominant reduction of bone mass in the trunk was not associated with the severity of airflow limitation but rather with body weight loss and exercise intolerance. These data suggest that body weight loss and exercise intolerance are important risk factors for vertebral fracture in patients with COPD.
尽管慢性阻塞性肺疾病（COPD）患者中低骨密度非常普遍，但骨量减少的分布情况尚未完全阐明。
确定COPD患者的局部骨量丢失情况，并研究分布变化是否可能与体重减轻和功能能力相关。
对45例男性COPD患者和12例年龄及性别匹配的对照受试者进行体重指数（BMI）评估，并通过双能X线吸收法得出手臂、腿部和躯干的骨矿物质含量指数（BMCI）的身高平方指数。进行肺功能测试，并测量最大摄氧量（VO2max）。
COPD患者全身、腿部和躯干的BMCI低于对照受试者，尽管两组之间手臂的BMCI相似。BMI与所有三个节段的BMCI均显著相关。以全身骨矿物质含量（BMC）的百分比表示的躯干骨矿物质含量（BMC躯干/BMC全身）与BMI显著相关。躯干的BMCI与VO2max密切相关，但与气流受限无关。
BMC减少存在区域差异，但躯干骨量的主要减少与气流受限的严重程度无关，而是与体重减轻和运动不耐受有关。这些数据表明，体重减轻和运动不耐受是COPD患者椎体骨折的重要危险因素。
