Du Xinxin, Nouraie S Mehdi, Pu Jiantao, Karoleski Chad, Sciurba Frank C, Greenspan Susan L, Bon Jessica
Division of Pulmonary Allergy Critical Care and Sleep, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A.
Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Osteoporos Int. 2025 Aug 19. doi: 10.1007/s00198-025-07648-1.
Low bone mineral density (BMD) increases fracture risk, poor life-quality, and death. Low BMD is prevalent in tobacco-exposed individuals with lung disease; however, they are not included in current screening guidelines. In our study, a majority of individuals with former tobacco exposure not meeting current screening criteria had low BMD.
Low bone mineral density (BMD) is prevalent in tobacco-exposed individuals with lung disease. Guidelines recommend dual x-ray absorptiometry (DXA) screening for osteoporosis in individuals with current tobacco use, but former tobacco use, chronic obstructive pulmonary disease (COPD), and emphysema are not recommended indications for screening. We hypothesized that tobacco-exposed individuals not meeting current osteoporosis screening guidelines have a high prevalence of low BMD, and that low BMD associates with lung-specific risk factors in this population.
We measured total hip, femoral neck, and lumbar spine BMD with DXA in a tobacco-exposed cohort of men and women 40 years of age and older with ≥ 10 pack years cigarette use. Osteoporosis screening eligibility was determined by modified Fracture Risk Assessment Tool (FRAX) criteria. We investigated lung-related factors associated with low BMD adjusting for age, sex, and diabetes.
Of 472 individuals with former tobacco exposure, 28% did not meet study-defined osteoporosis screening criteria. Of participants not meeting screening criteria, 55% had low BMD on DXA assessment. The presence of CT-determined emphysema was associated with low BMD (adjusted OR 2.1, 95% CI [1.02, 4.42]) in participants not eligible for osteoporosis screening. Lung function, respiratory symptoms, pack years cigarette use, and inhaled corticosteroid use were not associated with low BMD.
Emphysema on chest CT scan independently associates with low BMD in tobacco-exposed individuals not meeting traditional osteoporosis screening criteria. These findings suggest that osteoporosis screening recommendations should include emphysema as a risk factor for early BMD assessment.
低骨密度（BMD）会增加骨折风险、降低生活质量并导致死亡。低骨密度在患有肺部疾病且接触过烟草的个体中很常见；然而，他们未被纳入当前的筛查指南。在我们的研究中，大多数不符合当前筛查标准的曾接触过烟草的个体骨密度较低。
低骨密度（BMD）在患有肺部疾病且接触过烟草的个体中很常见。指南建议对当前仍在吸烟的个体进行双能X线吸收法（DXA）骨质疏松筛查，但不建议对曾吸烟、患有慢性阻塞性肺疾病（COPD）和肺气肿的个体进行筛查。我们假设，不符合当前骨质疏松筛查指南的接触过烟草的个体中，低骨密度的患病率很高，并且在该人群中低骨密度与肺部特定风险因素相关。
我们使用DXA测量了40岁及以上、吸烟史≥10包年的接触过烟草的男性和女性队列的全髋、股骨颈和腰椎骨密度。通过改良的骨折风险评估工具（FRAX）标准确定骨质疏松筛查资格。我们研究了在调整年龄、性别和糖尿病因素后与低骨密度相关的肺部相关因素。
在472名曾接触过烟草的个体中，28%不符合研究定义的骨质疏松筛查标准。在不符合筛查标准的参与者中，55%在DXA评估中骨密度较低。在不符合骨质疏松筛查资格的参与者中，CT确定的肺气肿的存在与低骨密度相关（调整后的OR为2.1，95%CI[1.02，4.42]）。肺功能、呼吸道症状、吸烟包年数和吸入性糖皮质激素的使用与低骨密度无关。
胸部CT扫描显示的肺气肿与不符合传统骨质疏松筛查标准的接触过烟草的个体的低骨密度独立相关。这些发现表明，骨质疏松筛查建议应将肺气肿作为早期骨密度评估的风险因素纳入其中。
