Smokers with emphysema and small airway disease on computed tomography have lower bone density

• Published in: International journal of chronic obstructive pulmonary disease 2016-01, Vol.11 (1), p.1207-1216
• Main Authors: Pompe, Esther, de Jong, Pim A, van Rikxoort, Eva M, Gallardo Estrella, Leticia, de Jong, Werner U, Vliegenthart, Rozemarijn, Oudkerk, Matthijs, van der Aalst, Carlijn M, van Ginneken, Bram, Lammers, Jan-Willem J, Mohamed Hoesein, Firdaus Aa
• Format: Article
• Language: English
• Subjects: Aged; air trapping; Belgium; Bone Density; Cancer screening; CAT scans; Chronic obstructive pulmonary disease; Computed Tomography; COPD; Diagnostic imaging; Disease Progression; Emphysema; Fractures; Humans; Linear Models; Logistic Models; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - injuries; Lumbar Vertebrae - physiopathology; Lung - physiopathology; Lung cancer; Male; Medical imaging; Medical screening; Middle Aged; Netherlands; Odds Ratio; Original Research; Osteoporosis; Osteoporosis - diagnostic imaging; Osteoporosis - etiology; Osteoporosis - physiopathology; Osteoporotic Fractures - diagnostic imaging; Osteoporotic Fractures - etiology; Osteoporotic Fractures - physiopathology; Predictive Value of Tests; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - etiology; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Emphysema - diagnosis; Pulmonary Emphysema - etiology; Pulmonary Emphysema - physiopathology; Review boards; Risk Factors; Severity of Illness Index; Smokers; Smoking - adverse effects; Spinal Fractures - diagnostic imaging; Spinal Fractures - etiology; Spinal Fractures - physiopathology; Tomography; Tomography, X-Ray Computed; Vertebrae
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S103680

Osteoporosis is more common in patients with COPD and in smokers. The aim of this study was to assess whether measures of emphysema and airway disease on computed tomography (CT) were associated with lower bone density or vertebral fractures in smokers with and without COPD. For this purpose, we included participants from the NELSON lung cancer screening trial. Bone density was measured as Hounsfield Units in the first lumbar vertebra, and vertebral fractures were assessed semiquantitatively. The 15th percentile method (Perc15) was used to assess emphysema, and the airway lumen perimeter (Pi10) was used for airway wall thickness. Expiratory/inspiratory-ratiomean lung density (E/I-ratioMLD) was used as a measure for air trapping and tracheal index to assess tracheal deformity. Linear regression models and logistic regression models were used to assess associations between CT biomarkers, bone density, and presence of fractures. Exactly 1,093 male participants were eligible for analysis. Lower Perc15 and higher E/I-ratioMLD were significantly associated with lower bone density (b=-1.27, P=0.02 and b=-0.37, P=0.02, respectively). Pi10 and tracheal index were not associated with bone density changes. CT-derived biomarkers were not associated with fracture prevalence. Bone density is lower with increasing extent of emphysema and small airway disease but is not associated with large airway disease and tracheal deformity. This may indicate the necessity to measure bone density early in smokers with emphysema and air trapping to prevent vertebral fractures.