Sakurai-Iesato Yoriko, Kawata Naoko, Tada Yuji, Iesato Ken, Matsuura Yukiko, Yahaba Misuzu, Suzuki Toshio, Ikari Jun, Yanagawa Noriyuki, Kasahara Yasunori, West James, Tatsumi Koichiro
Department of Respirology, Graduate School of Medicine, Chiba University, Japan.
Department of Medicine, Vanderbilt University Medical Center, USA.
Intern Med. 2017;56(14):1781-1790. doi: 10.2169/internalmedicine.56.6910. Epub 2017 Jul 15.
Objective Osteoporosis, which is now recognized as a major comorbidity of chronic obstructive pulmonary disease (COPD), must be diagnosed by appropriate methods. The aims of this study were to clarify the relationships between bone mineral density (BMD) and COPD-related clinical variables and to explore the association of BMD with the updated Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification in men. Methods We enrolled 50 Japanese men with clinically stable COPD who underwent dual-energy X-ray absorptiometry (DEXA), pulmonary function testing, and computerized tomography (CT) and who had completed a questionnaire (COPD assessment test [CAT]). We determined the association between the T-score and other tested parameters and compared the BMD of patients in each GOLD category. Results Twenty-three of the 50 patients (46.0%) were diagnosed with osteopenia, and 7 (14.0%) were diagnosed with osteoporosis. The BMD findings were significantly correlated with the CAT score, forced expiratory volume in 1 second percentage predicted (FEV% predicted), low attenuation volume percentage (LAV%), and percentage of cross-sectional area of small pulmonary vessels (%CSA) on CT images. Notably, the median T-score of the GOLD category D participants was significantly lower than that of the participants in each of the other categories (A [-0.98], B [-1.06], C [-1.05], and D [-2.19], p<0.05). Conclusion Reduced BMD was associated with airflow limitation, extent of radiographic findings, and a poor quality of life (QOL) in patients with COPD. The BMD of GOLD category D patients was the lowest of all of the patients evaluated, and category D patients may benefit from active intervention for osteoporosis.
目的 骨质疏松症现已被公认为慢性阻塞性肺疾病（COPD）的一种主要合并症，必须通过适当的方法进行诊断。本研究的目的是阐明骨密度（BMD）与COPD相关临床变量之间的关系，并探讨男性中BMD与更新后的慢性阻塞性肺疾病全球倡议（GOLD）分级的关联。方法 我们纳入了50名临床病情稳定的日本男性COPD患者，这些患者接受了双能X线吸收法（DEXA）、肺功能测试和计算机断层扫描（CT），并完成了一份问卷（COPD评估测试[CAT]）。我们确定了T值与其他测试参数之间的关联，并比较了每个GOLD分级患者的骨密度。结果 50名患者中有23名（46.0%）被诊断为骨量减少，7名（14.0%）被诊断为骨质疏松症。骨密度结果与CAT评分、1秒用力呼气容积占预计值百分比（FEV%预计值）、低衰减容积百分比（LAV%）以及CT图像上小肺血管横截面积百分比（%CSA）显著相关。值得注意的是，GOLD分级D组参与者的中位T值显著低于其他各组参与者（A组[-0.98]、B组[-1.06]、C组[-1.05]和D组[-2.19]，p<0.05）。结论 COPD患者骨密度降低与气流受限、影像学表现程度及生活质量（QOL）差有关。GOLD分级D组患者的骨密度在所有评估患者中最低，D组患者可能受益于骨质疏松症的积极干预。
