Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
BMC Pulm Med. 2022 May 21;22(1):202. doi: 10.1186/s12890-022-01991-3.
Since nontuberculous mycobacterial pulmonary disease (NTM-PD) is common in middle-aged/elderly slender women at risk of osteoporosis, we hypothesized that NTM-PD could be associated with osteoporosis. The study aimed to evaluate the prevalence of osteoporosis in patients with NTM-PD compared with that in the general population and determine the factors associated with osteoporosis in the subjects, including the serum estradiol (E) and 25-hydroxyvitamin D (25OHD) levels.
We have recruited 228 consecutive adult patients with NTM-PD from a prospective cohort study at the Keio University Hospital, who had no history of osteoporosis or osteoporosis-associated bone fracture but underwent dual-energy X-ray absorptiometry-based bone mineral density (BMD) evaluation from August 2017-September 2019. The E and 25OHD levels were measured in 165 patients with available stored serum samples. We performed multivariable logistic regression analyses for osteopenia and osteoporosis.
Osteoporosis (T-score ≤ - 2.5) and osteopenia (T-score - 1 to - 2.5) were diagnosed in 35.1% and 36.8% of patients with NTM-PD, respectively. Compared with the general population, the proportion of osteoporosis was significantly higher in 50-59-, 60-69-, and 70-79-year-old women with NTM-PD. Multivariable analysis revealed that older age (adjusted odds ratio [aOR] for 1-year increase = 1.12; 95% confidence interval [CI] = 1.07-1.18), female sex (aOR = 36.3; 95% CI = 7.57-174), lower BMI (aOR for 1 kg/m decrease = 1.37; 95% CI = 1.14-1.65), and chronic Pseudomonas aeruginosa (PA) infection (aOR = 6.70; 95% CI = 1.07-41.8) were independently associated with osteoporosis. Additionally, multivariable analysis in 165 patients whose serum E and 25OHD levels were measured showed that both low E levels (< 10 pg/mL) and lower 25OHD levels were independently associated with osteoporosis.
Middle-aged/elderly women with NTM-PD have a higher prevalence of osteoporosis than the general population. BMD screening should be considered in NTM-PD, especially in older females with severe diseases such as chronic PA infection and lower BMI, and low serum E and 25OHD levels.
由于非结核分枝杆菌肺病（NTM-PD）常见于有骨质疏松风险的中年/老年消瘦女性，我们假设 NTM-PD 可能与骨质疏松有关。本研究旨在评估与普通人群相比，NTM-PD 患者骨质疏松的患病率，并确定与受试者骨质疏松相关的因素，包括血清雌二醇（E）和 25-羟维生素 D（25OHD）水平。
我们从庆应义塾大学医院的一项前瞻性队列研究中招募了 228 例连续的成人 NTM-PD 患者，这些患者无骨质疏松或与骨质疏松相关的骨折病史，但在 2017 年 8 月至 2019 年 9 月期间接受了基于双能 X 线吸收法的骨矿物质密度（BMD）评估。在有可用储存血清样本的 165 例患者中测量了 E 和 25OHD 水平。我们对骨质疏松症和骨质疏松症进行了多变量逻辑回归分析。
35.1%和 36.8%的 NTM-PD 患者分别诊断为骨质疏松症（T 评分≤-2.5）和骨量减少症（T 评分-1 至-2.5）。与普通人群相比，50-59 岁、60-69 岁和 70-79 岁的 NTM-PD 女性骨质疏松症的比例明显更高。多变量分析显示，年龄较大（每增加 1 岁，调整后的优势比[aOR]为 1.12；95%置信区间[CI]为 1.07-1.18）、女性（aOR=36.3；95%CI=7.57-174）、较低的 BMI（每减少 1kg/m2，aOR 为 1.37；95%CI=1.14-1.65）和慢性铜绿假单胞菌（PA）感染（aOR=6.70；95%CI=1.07-41.8）与骨质疏松症独立相关。此外，在测量了血清 E 和 25OHD 水平的 165 例患者的多变量分析中，低 E 水平（<10pg/mL）和低 25OHD 水平均与骨质疏松症独立相关。
与普通人群相比，患有 NTM-PD 的中年/老年女性骨质疏松症的患病率更高。在 NTM-PD 中应考虑进行 BMD 筛查，特别是在患有慢性 PA 感染和 BMI 较低等严重疾病的老年女性中，以及血清 E 和 25OHD 水平较低的患者中。
