Fouda Mona Ali, Alhamad Esam Hamad, Al-Hajjaj Mohammed Saleh, Shaik Shaffi Ahmed, Alboukai Ahmad Amer, Al-Kassimi Feisal Abdulla
Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia.
Ann Thorac Med. 2017 Apr-Jun;12(2):101-106. doi: 10.4103/atm.ATM_357_16.
Osteoporosis, the most common extra-pulmonary complication of chronic obstructive pulmonary disease (COPD), may be related to general causes or COPD-specific causes such as low forced expiratory volume in 1 s (FEV1) and hypoxia. A few studies reported that emphysema is an independent risk factor for osteoporosis. However, other workers considered the association to be confounded by low FEV1 and low body mass index (BMI) which cluster with emphysema.
To study the association between osteoporosis and emphysema in a model that includes these potentially confounding factors.
We studied prospectively 52 COPD patients with both high resolution computed tomography and carbon monoxide diffusion coefficient as diagnostic markers of emphysema. Dual-energy X-ray absorptiometry was used to measure the bone mass density (BMD) of lumbar vertebrae and neck of the femur. Vertebral fractures were evaluated using the Genant semiquantitative score. Multiple linear regression analysis was used to identify the following independent variables: age, BMI, FEV1% predicted, PaO, emphysema score, C-reactive protein (CRP), and dyspnea score as related to BMD. ≤ 0.05 was considered statistically significant.
There was no significant difference in the serum Vitamin D levels, vertebral fracture score, or BMD between the emphysematous and nonemphysematous patients. Multivariate analysis showed that (in a model including age, BMI, FEV1, PaO, emphysema score, CRP, and dyspnea score) only reduced BMI, FEV1, and PaO were independent risk factors for low BMD.
The emphysematous phenotype is not a risk factor for osteoporosis independently of BMI, FEV1, and PaO.
骨质疏松症是慢性阻塞性肺疾病（COPD）最常见的肺外并发症，可能与一般病因或COPD特异性病因有关，如1秒用力呼气容积（FEV1）降低和低氧血症。一些研究报告称，肺气肿是骨质疏松症的独立危险因素。然而，其他研究人员认为这种关联被与肺气肿聚集在一起的低FEV1和低体重指数（BMI）所混淆。
在一个包含这些潜在混杂因素的模型中研究骨质疏松症与肺气肿之间的关联。
我们前瞻性地研究了52例COPD患者，将高分辨率计算机断层扫描和一氧化碳弥散系数作为肺气肿的诊断标志物。采用双能X线吸收法测量腰椎和股骨颈的骨密度（BMD）。使用Genant半定量评分评估椎体骨折情况。多元线性回归分析用于确定以下独立变量：年龄、BMI、预测FEV1%、动脉血氧分压（PaO）、肺气肿评分、C反应蛋白（CRP）以及与BMD相关的呼吸困难评分。P≤0.05被认为具有统计学意义。
肺气肿患者和非肺气肿患者的血清维生素D水平、椎体骨折评分或BMD之间无显著差异。多变量分析显示（在一个包括年龄、BMI、FEV1、PaO、肺气肿评分、CRP和呼吸困难评分的模型中），仅BMI降低、FEV1降低和PaO降低是低BMD的独立危险因素。
独立于BMI、FEV1和PaO，肺气肿表型不是骨质疏松症的危险因素。
