de Jong Werner U, de Jong Pim A, Vliegenthart Rozemarijn, Isgum Ivana, Lammers Jan-Willem J, Oudkerk Matthijs, van der Aalst Carlijn, de Koning Harry J, Mohamed Hoesein Firdaus A
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Bone Miner Res. 2014 Oct;29(10):2224-9. doi: 10.1002/jbmr.2248.
We studied the vertebral fracture prevalence on low-dose chest computed tomography (CT) in male lung cancer screening participants and the association of fractures and bone density with chronic obstructive pulmonary disease (COPD) and smoking. 1140 male current and former smokers with ≥ 16.5 packyears from the NELSON lung cancer screening trial were included. Age, body mass index, and smoking status were registered. CT scans and pulmonary function tests were obtained on the same day. On CT, vertebral fractures and bone density were measured. The cohort had a mean age of 62.5 years (standard deviation 5.2) old; 531 (46.6%) had quit smoking; and 437 (38.3%) had COPD. Of the group, 100 (8.8%) participants had a vertebral fracture. Fracture prevalence was higher in current compared to former smokers (11.3% versus 5.8%, p = 0.001), but similar in participants with COPD compared to those without (9.6% versus 8.3%, p = 0.430). The multivariable adjusted odds ratio for fracture presence was 1.79 (95% CI: 1.13-2.84) in current smokers and 1.08 (95% CI: 0.69-1.67) in COPD participants. Bone density was lower in current compared to former smokers (103.2 HU versus 108.7 HU, p = 0.006) and in participants with COPD compared to those without [100.7 Hounsfield Units (HU) versus 108.9 HU, p < 0.001]. In multivariate analysis, smoking status and COPD status were independently associated with bone density, corrected for age and body mass index. In conclusion, our study shows that lung cancer screening participants have a substantial vertebral fracture burden. Fractures are more common in current smokers, who also have lower bone density. We could not confirm that COPD is independently associated with vertebral fractures.
我们研究了男性肺癌筛查参与者低剂量胸部计算机断层扫描（CT）上椎体骨折的患病率，以及骨折和骨密度与慢性阻塞性肺疾病（COPD）和吸烟之间的关联。纳入了来自NELSON肺癌筛查试验的1140名吸烟量≥16.5包年的男性现吸烟者和既往吸烟者。记录了年龄、体重指数和吸烟状况。在同一天进行CT扫描和肺功能测试。在CT上测量椎体骨折和骨密度。该队列的平均年龄为62.5岁（标准差5.2岁）；531人（46.6%）已戒烟；437人（占38.3%）患有慢性阻塞性肺疾病。在该组中，100名（8.8%）参与者有椎体骨折。现吸烟者的骨折患病率高于既往吸烟者（11.3%对5.8%，p = 0.001），但患有慢性阻塞性肺疾病的参与者与未患慢性阻塞性肺疾病的参与者相似（9.6%对8.3%，p = 0.430）。现吸烟者骨折存在的多变量调整优势比为1.79（95%CI：1.13 - 2.84），慢性阻塞性肺疾病参与者为1.08（95%CI：0.69 - 1.67）。现吸烟者的骨密度低于既往吸烟者（103.2HU对108.7HU，p = 0.006），患有慢性阻塞性肺疾病的参与者低于未患慢性阻塞性肺疾病的参与者[100.7亨氏单位（HU）对108.9HU，p < 0.001]。在多变量分析中，校正年龄和体重指数后，吸烟状况和慢性阻塞性肺疾病状况与骨密度独立相关。总之，我们的研究表明，肺癌筛查参与者有相当大的椎体骨折负担。骨折在现吸烟者中更常见，他们的骨密度也较低。我们无法证实慢性阻塞性肺疾病与椎体骨折独立相关。
