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Alghadir AH, Gabr SA, Iqbal A. Hand grip strength, vitamin D status, and diets as predictors of bone health in 6-12 years old school children. BMC Musculoskelet Disord 2023; 24:830. [PMID: 37872520 PMCID: PMC10594896 DOI: 10.1186/s12891-023-06960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Vitamin D and calcium-rich foods, exposure to sunlight, and physical activities (PA) play a pivotal role in promoting the production of sufficient vitamin D and improving grip strength needed for better bone health among school children. PURPOSE This study aimed to determine the effects of hand grip muscle strength (HGS), vitamin D in addition to diets, and PA on bone health status among 6-12 years old schoolchildren. METHODS This study was based on a cross-sectional observational design, which was descriptive in nature. A diverse sample of 560 elementary school children aged 6-12 years old were invited to participate in this descriptive cross-sectional study. The Dual-Energy X-Ray Absorptiometry (DXA), QUS technique, and ACTi graph GT1M accelerometer were used respectively as a valid tools to identify BMD, BMC, and other parameters of bone health like c-BUA values and bone stiffness (SI), and physical activity (PA) of all individuals participated in this study. In addition, a hydraulic dynamometer was used to measure hand grip strength among the participants. Moreover, an immunoassay technique was used to measure the serum levels of vitamin 25(OH)D level, and bone metabolism markers; NTX, DPD, Ca, and sBAP in all participants. Bone loss (osteoporosis) was cross-sectionally predicted in 19.64% of the total population, most of whom were girls (14.3% vs. 5.4% for boys; P = 0.01). Compared to boys, the incidence of osteoporosis was higher and significantly correlated in girls with lower HGS, deficient vitamin D, inadequate vitamin D and Ca intake, greater adiposity, poor PA, and lower sun exposure. Also, in girls, lower vitamin 25(OH)D levels, and poor HGS were shown to be significantly associated with lower values of BMD, BMC, SI, and higher values of bone resorption markers; NTX, DPD, and sBAP and lower serum Ca than do in boys. The findings suggested that deficient vitamin D, lower HGS, adiposity, PA, and sun exposure as related risk factors to the pravelence of bone loss among school children, particularly in girls. In addition, these parameters might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts; however, more studies are required.
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Affiliation(s)
- Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Sami A Gabr
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Amir Iqbal
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia.
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Zhang X, Ding K, Miao X, Wang J, Hu B, Shen J, Hu X, Xu Y, Yu B, Tu T, Lin A, Chen X, Huang Y. Associations between bone mineral density and chronic obstructive pulmonary disease. J Int Med Res 2022; 50:3000605221094644. [PMID: 35579181 PMCID: PMC9127852 DOI: 10.1177/03000605221094644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the relationship between chronic obstructive pulmonary disease (COPD) severity and bone mineral density (BMD) in the whole body and different body areas. Methods This retrospective, cross-sectional study included patients with COPD. Demographic and lung function data, COPD severity scales, BMD, and T scores were collected. Patients were grouped by high (≥–1) and low (<–1) T scores, and stratified by body mass index, airway obstruction, dyspnoea, and exercise capacity (BODE) index. The relationship between whole-body BMD and BODE was evaluated by Kendall’s tau-b correlation coefficient. Risk factors associated with COPD severity were identified by univariate analyses. BMD as an independent predictor of severe COPD (BODE ≥5) was verified by multivariate logistic regression. BMD values in different body areas for predicting severe COPD were assessed by receiver operating characteristic curves. Results Of 88 patients with COPD, lung-function indicators and COPD severity were significantly different between those with high and low T scores. Whole-body BMD was inversely related to COPD severity scales, including BODE. Multivariate logistic regression revealed that BMD was independently associated with COPD severity. The area under the curve for pelvic BMD in predicting severe COPD was 0.728. Conclusion BMD may be a novel marker in predicting COPD severity, and pelvic BMD may have the strongest relative predictive power.
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Affiliation(s)
- Xiaodiao Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Keke Ding
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xiaqi Miao
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jianing Wang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Binbin Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jiamin Shen
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xueting Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Yage Xu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Beibei Yu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tingting Tu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Aiju Lin
- Department of Endocrinology, Bone Density Research Laboratory, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xianjing Chen
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yiben Huang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Zeng X, Liu D, Zhao X, Chao L, Li Y, Li H, Li W, Gui L, Wu W. Association of bone mineral density with lung function in a Chinese general population: the Xinxiang rural cohort study. BMC Pulm Med 2019; 19:239. [PMID: 31818275 PMCID: PMC6902516 DOI: 10.1186/s12890-019-1008-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022] Open
Abstract
Background Bone mineral density (BMD) has been positively associated with lung function in patients diagnosed with respiratory diseases such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis. However, the relationship between BMD and lung function is inconsistent in the general population. Methods To investigate the association between BMD and lung function in a Chinese general population, a total of 1024 adults aged 40–70 years old from Qiliying (an industrial polluted exposure area) and Langgongmiao (the reference area with non-industrial pollution) were recruited and underwent BMD and spirometry tests. Results Both BMD and lung function levels were lower in the exposed area compared to the reference area. In addition, BMD and lung function levels were also lower in females compared to males. Both Spearman and partial correlation analyses showed that BMD was positively correlated with FVC and FEV1. After adjusting linear regression analyses for potential confounding factors, every 0.1 g/cm2 drop in BMD was associated with 53.0 mL decrease in FVC and 33.5 mL decrease in FEV1. Conclusions A reduction of BMD is associated with lower lung function in a general population from China.
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Affiliation(s)
- Xiang Zeng
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China.,Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China.,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Dongling Liu
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, China
| | - Xiangmei Zhao
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Ling Chao
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Yuchun Li
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Huijun Li
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Wen Li
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Lihui Gui
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Weidong Wu
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China. .,Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China. .,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
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Cossio-Bolaños M, Lee-Andruske C, de Arruda M, Luarte-Rocha C, Almonacid-Fierro A, Gómez-Campos R. Hand grip strength and maximum peak expiratory flow: determinants of bone mineral density of adolescent students. BMC Pediatr 2018; 18:96. [PMID: 29499680 PMCID: PMC5834893 DOI: 10.1186/s12887-018-1015-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background Maintaining and building healthy bones during the lifetime requires a complicated interaction between a number of physiological and lifestyle factors. Our goal of this study was to analyze the association between hand grip strength and the maximum peak expiratory flow with bone mineral density and content in adolescent students. Methods The research team studied 1427 adolescent students of both sexes (750 males and 677 females) between the ages of 11.0 and 18.9 years in the Maule Region of Talca (Chile). Weight, standing height, sitting height, hand grip strength (HGS), and maximum peak expiratory flow (PEF) were measured. Furthermore, bone mineral density (BMD) and total body bone mineral content (BMC) were determined by using the Dual-Energy X-Ray Absorptiometry (DXA). Hand grip strength and PEF were categorized in tertiles (lowest, middle, and highest). Linear regression was performed in steps to analyze the relationship between the variables. Differences between categories were determined through ANOVA. Results In males, the hand grip strength explained 18–19% of the BMD and 20–23% of the BMC. For the females, the percentage of variation occurred between 12 and 13% of the BMD and 17–18% of the BMC. The variation of PEF for the males was observed as 33% of the BMD and 36% of the BMC. For the females, both the BMD and BMC showed a variation of 19%. The HGS and PEF were divided into three categories (lowest, middle, and highest). In both cases, significant differences occurred in bone density health between the three categories. Conclusions In conclusion, the HGS and the PEF related positively to the bone density health of both sexes of adolescent students. The adolescents with poor values for hand grip strength and expiratory flow showed reduced values of BMD and BMC for the total body. Furthermore, the PEF had a greater influence on bone density health with respect to the HGS of the adolescents of both sexes.
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Affiliation(s)
- Marco Cossio-Bolaños
- Faculty of Physical Education, State University of Campinas, Campinas, Brazil.,Departamento de Ciencias de la Actividad Física, Universidad Católica del Maule, Talca, Chile.,Universidad Nacional de San Agustín, Arequipa, Peru
| | - Cynthia Lee-Andruske
- Red Iberoamericana de Investigación en Desarrollo Biológico Humano, Arequipa, Peru
| | - Miguel de Arruda
- Faculty of Physical Education, State University of Campinas, Campinas, Brazil
| | | | | | - Rossana Gómez-Campos
- Faculty of Physical Education, State University of Campinas, Campinas, Brazil. .,Universidad Nacional de San Agustín, Arequipa, Peru. .,Universidad Autónoma de Chile, 5 Poniente, 1670, Talca, Chile.
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Watanabe R, Shiraki M, Saito M, Okazaki R, Inoue D. Restrictive pulmonary dysfunction is associated with vertebral fractures and bone loss in elderly postmenopausal women. Osteoporos Int 2018; 29:625-633. [PMID: 29218382 DOI: 10.1007/s00198-017-4337-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/01/2017] [Indexed: 12/14/2022]
Abstract
UNLABELLED Association between lung function and bone metabolism remains controversial. We found that impaired lung function was associated with vertebral fractures and bone loss in Japanese postmenopausal women. While vertebral deformities would impair lung function, respiratory dysfunction might in turn increase fracture risk, suggesting a complex bidirectional interaction. INTRODUCTION Association between bone metabolism and pulmonary function in the general population is controversial. The aim of this study was to investigate relationship between lung and bone parameters in elderly postmenopausal women. METHODS One hundred and six postmenopausal women (75.6 ± 8.0 years old) who underwent spirometric tests were examined for prevalent vertebral fractures, bone mineral density (BMD), bone metabolic markers, and other metabolic indices such as urinary pentosidine. RESULTS Multivariable logistic regression analyses revealed that forced vital capacity (FVC) (OR = 0.063, 95% CI: 0.011-0.352, p = 0.002) and urinary pentosidine (OR = 1.067, 95% CI: 1.020-1.117, p = 0.005) were associated with the presence of vertebral fractures after adjustment for height loss, age, and BMD at femoral neck. Moreover, vital capacity (VC) or FVC as well as body mass index and age was among independent determinants of BMD after adjustment for height loss and the number and grade of vertebral fractures in forced multiple linear regression analysis (VC: β = 0.212, p = 0.021, FVC: β = 0.217, p = 0.031). Urinary pentosidine was negatively correlated with pulmonary function parameters such as FVC and forced expiratory volume in 1 s (FEV1.0), although these correlations appeared dependent on age. CONCLUSIONS Diminished FVC was associated with prevalent vertebral fractures and decreased BMD in Japanese postmenopausal women without apparent pulmonary diseases. Mechanism of such association between pulmonary function and bone status remains to be determined.
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Affiliation(s)
- R Watanabe
- Third Department of Medicine, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-shi, Chiba, 299-0111, Japan
| | - M Shiraki
- Research Institute and Practice for Involutional Diseases, 1610-1 Meisei, Misato, Azumino, Nagano, 399-8101, Japan
| | - M Saito
- Department of Orthopaedic Surgery, Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, 105-1471, Japan
| | - R Okazaki
- Third Department of Medicine, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-shi, Chiba, 299-0111, Japan
| | - D Inoue
- Third Department of Medicine, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-shi, Chiba, 299-0111, Japan.
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Anar C, Yüksel Yavuz M, Güldaval F, Varol Y, Kalenci D. Assessment of osteoporosis using the FRAX method and the importance of vitamin D levels in COPD patients. Multidiscip Respir Med 2018; 13:1. [PMID: 29318009 PMCID: PMC5756431 DOI: 10.1186/s40248-017-0116-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/01/2017] [Indexed: 01/09/2023] Open
Abstract
Background The aim of this paper was to evaluate the availability of FRAX for assessing osteoporosis risk, and to demonstrate the importance of vitamin D levels in COPD patients. Methods Fourty-six males who fulfilled the COPD diagnostic criteria defined by GOLD were included. Age, race, BMI, physical activity frequency, smoking and dietary habits, age at COPD diagnosis, disease duration, fractures history, and medications use were determined. Levels of 25(OH)D were detected. BMD was measured by DXA at lumbar spine, femoral neck, and entire femur, and classified according to ISCD. FRAX score was calculated. Control group was composed of 40 non-smoker individuals without previous history of pulmonary diseases. Results 25(OH)D levels were significantly different between patients and controls. In the COPD group, a statistically significant difference in vitamin D levels was detected among the A, B, C, and D grades, while no such significant differences in FRAX scores were detected. 25(OH)D levels were significantly low in COPD patients with disease exacerbations and hospitalizations in the previous one year. No correlation was detected between vitamin D levels and the FRAX score. A positive correlation was observed between vitamin D levels and T-score. FRAX scores were higher and vitamin D levels were lower in osteoporotic COPD patients than in non-osteoporotic COPD patients. Conclusion Using FRAX for assessing osteoporosis in COPD can reduce fracture risk and allow adequate treatment. Since vitamin D levels are related to exacerbations and hospitalizations, vitamin D supplementation may be needed in COPD patients, especially in those with high FRAX scores.
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Affiliation(s)
- Ceyda Anar
- Department of Chest Diseases, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, Gaziler Cad. No: 331, 35110 İzmir, Turkey
| | - Melike Yüksel Yavuz
- Department of Chest Diseases, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, Gaziler Cad. No: 331, 35110 İzmir, Turkey
| | - Filiz Güldaval
- Department of Chest Diseases, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, Gaziler Cad. No: 331, 35110 İzmir, Turkey
| | - Yelda Varol
- Department of Chest Diseases, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, Gaziler Cad. No: 331, 35110 İzmir, Turkey
| | - Dilek Kalenci
- Department of Biochemistry, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, İzmir, Turkey
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Lee JH, Hong AR, Kim JH, Kim KM, Koo BK, Shin CS, Kim SW. Amount of smoking, pulmonary function, and bone mineral density in middle-aged Korean men: KNHANES 2008-2011. J Bone Miner Metab 2018; 36:95-102. [PMID: 28144749 DOI: 10.1007/s00774-017-0811-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/15/2016] [Indexed: 01/21/2023]
Abstract
Smoking induces bone loss; however, data on the relationship between smoking history and bone mineral density (BMD) are lacking. Age and pulmonary function can affect BMD. We investigated the relationships among pack-years (PYs) of smoking, pulmonary function, and BMD in middle-aged Korean men (50-64 years old). This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey, 2008-2011. All participants underwent BMD measurements using dual energy X-ray absorptiometry and pulmonary function tests using standardized spirometry. In total, 388 never-smokers and 1088 ever-smokers were analyzed. The number of PYs of smoking was negatively correlated with total hip BMD (r = -0.088; P = 0.004) after adjusting for age, height, and weight. Ever-smokers were classified into 3 groups according to PYs of smoking. The highest tertile (n = 482) exhibited significantly lower total hip bone mass than the lowest tertile (n = 214) after adjusting for confounding factors (age, height, weight, forced expiratory volume in 1 s (FEV1), alcohol consumption, physical activity, and vitamin D levels) that could affect bone metabolism (P = 0.003). In conclusion, smoking for >30 PYs was significantly associated with low hip BMD after adjusting for pulmonary function in middle-aged Korean men. Long-term smoking may be a risk factor for bone loss in middle-aged men independent of age, height, weight, and pulmonary function.
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Affiliation(s)
- Ji Hyun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - A Ram Hong
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 156-707, South Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
- Department of Internal Medicine, Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 156-707, South Korea.
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Mathiesen IH, Pressler T, Oturai P, Katzenstein TL, Skov M, Frikke-Schmidt R, Hitz MF. Osteoporosis Is Associated with Deteriorating Clinical Status in Adults with Cystic Fibrosis. Int J Endocrinol 2018; 2018:4803974. [PMID: 29780417 PMCID: PMC5892249 DOI: 10.1155/2018/4803974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/22/2017] [Accepted: 01/18/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) patients are in increased risk of osteoporosis. We aimed to determine the osteoporosis prevalence in an adult CF cohort and investigate calcium metabolic parameters and clinical status' association with bone mineral density evaluated by dual X-ray absorptiometry scan. METHODS We performed a cross section database study of adults at a tertiary CF Center. Z scores were applied for patients < 50 years of age and T scores for patients > 50 years of age. RESULTS One hundred twenty-five patients were included. Compared to nonosteoporotic patients, osteoporotic patients (15%) had significantly lower percent predicted forced expiratory volume in 1 second (ppFEV1), lower body mass index, higher frequency of CF-related diabetes and chronic lung infection, and higher high-sensitive C-reactive protein and glycated hemoglobin levels. Vitamin D was not associated with any outcome. In multivariate analyses, only ppFEV1 and female gender were independently associated with Z scores. CONCLUSIONS Osteoporosis in CF occurs with deteriorating clinical status while the role of calcium metabolism seems minor. Gender specific and dysglycemic impact on bone status should be investigated further.
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Affiliation(s)
- Inger Hee Mathiesen
- Department of Infectious Diseases, Copenhagen Cystic Fibrosis Center, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tacjana Pressler
- Department of Infectious Diseases, Copenhagen Cystic Fibrosis Center, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Danish Pediatric Pulmonary Service, Copenhagen Cystic Fibrosis Center, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Terese Lea Katzenstein
- Department of Infectious Diseases, Copenhagen Cystic Fibrosis Center, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Marianne Skov
- Danish Pediatric Pulmonary Service, Copenhagen Cystic Fibrosis Center, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mette Friberg Hitz
- Department of Medicine, Endocrine Division, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
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Cvijetić S, Pipinić IS, Varnai VM, Macan J. Relationship between ultrasound bone parameters, lung function, and body mass index in healthy student population. Arh Hig Rada Toksikol 2017; 68:53-58. [PMID: 28365676 DOI: 10.1515/aiht-2017-68-2869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/01/2016] [Indexed: 12/13/2022] Open
Abstract
Low bone mineral density has been reported in paediatric and adult patients with different lung diseases, but limited data are available on the association between lung function and bone density in a healthy young population. We explored the predictors of association between bone mass and pulmonary function in healthy first-year university students, focusing on body mass index (BMI). In this cross-sectional study we measured bone density with ultrasound and lung function with spirometry in 370 university students (271 girls and 99 boys). Information on lifestyle habits, such as physical activity, smoking, and alcohol consumption were obtained with a questionnaire. All lung function and bone parameters were significantly higher in boys than in girls (P<0.001). Underweight students had a significantly lower forced vital capacity (FVC%) (P=0.001 girls; P=0.012 boys), while overweight students had a significantly higher FVC% than normal weight students (P=0.024 girls; P=0.001 boys). BMI significantly correlated with FVC% (P=0.001) and forced expiratory volume in 1 second (FEV1 %) in both genders (P=0.001 girls; P=0.018 boys) and with broadband ultrasound attenuation (BUA) in boys. There were no significant associations between any of the bone and lung function parameters either in boys or girls. The most important determinant of lung function and ultrasound bone parameters in our study population was body mass index, with no direct association between bone density and lung function.
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Affiliation(s)
- Selma Cvijetić
- Institute for Medical Research and Occupational Health, Ksaverska cesta 2, 10000 Zagreb
| | | | | | - Jelena Macan
- Institute for Medical Research and Occupational Health, Zagreb
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Rodrigues IG, Barros MBDA. Osteoporosis self-reported in the elderly: a population-based survey in the city of Campinas, São Paulo, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 19:294-306. [PMID: 27532753 DOI: 10.1590/1980-5497201600020007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 12/14/2015] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Osteoporosis is a multifactorial disease that predisposes individuals to suffer falls and fractures, causing functional impairment and a consequent reduction in quality of life. OBJECTIVE To assess the prevalence and factors associated with self-reported osteoporosis in the elderly population living in Campinas, São Paulo, Brazil (ISACAMP 2008). METHODS Cross-sectional study with a random sample taken by conglomerates in 2 stages totaling 1,419 elderly people living in the urban area. The self-reported prevalence of osteoporosis was estimated according to socioeconomic and demographic variables, morbidity, health behaviors and problems. Crude prevalence ratios were estimated and adjusted by means of simple and multiple regressions using the Poisson svy commands in Stata 11.0 software. RESULTS We found a prevalence of osteoporosis of 14.8%, and significantly higher in females, in individuals who reported white skin, those who reported less than 7 hours of sleep/day, in patients with rheumatism/arthritis/arthrosis, asthma/bronchitis/emphysema, tendinitis, dizziness, insomnia, common mental disorders, BMI < 27, health self-related as bad and very bad, and reporting falls occurring in the last 12 months. CONCLUSION The present study, by identifying the factors associated with osteoporosis, identified segments of older people with a higher prevalence of the disease; to this information may contribute to the planning of public health policies and programs aimed at controlling the disease and its consequences.
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Affiliation(s)
- Iara Guimarães Rodrigues
- Faculdade de Ciências Médicas, Departamento de Saúde Coletiva. Universidade Estadual de Campinas - Campinas (SP), Brasil
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The Association Between Bone Mineral Density and Airflow Limitation in a Cohort of Fit Elderly Women. Lung 2016; 194:897-904. [PMID: 27699476 DOI: 10.1007/s00408-016-9948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE As studies examining the association between bone mineral density (BMD) and airflow limitation (AL) have produced conflicting results, the current one set out to analyze if and to what degree there are any correlations between these variables in a population of fit elderly women. METHODS One hundred and twenty-one non-smoking, fit and healthy women (age ≥ 65 years) underwent anthropometric assessment, laboratory testing (serum 25-hydroxy vitamin D, parathormone, and cytokine levels), pulmonary function testing (PFT), and dual-energy X-ray absorptiometry to evaluate BMD values of the lumbar and femoral regions. RESULTS A significant positive association was found between FEV1/FVC ratio (Tiffeneau index), a sensitive index of AL, and lumbar and femoral BMD; a 10 % increase in the FEV1/FVC ratio resulted in a significant increase of 0.025 g/cm2 in the total hip (p = 0.05), 0.027 g/cm2 in the femoral neck (p = 0.02), 0.028 g/cm2 in the femoral trochanter (p = 0.01), and 0.047 g/cm2 in the lumbar (p = 0.03) BMDs. Binary logistic analyses demonstrated more than a threefold higher risk of low BMD values for the lowest FEV1/FVC quartile in the lumbar (OR 4.62, 95 % CI 1.48-14.40, p = 0.008), total hip (OR 4.09, 95 % CI 1.28-13.05, p = 0.02 for the second quartile), and femoral trochanter regions (OR 3.90, 95 % CI 1.25-12.20, p = 0.02 for the third quartile). CONCLUSIONS AL was associated with a higher risk of reduced BMD in healthy, fit elderly women.
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12
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Lee IS, Leem AY, Lee SH, Rhee Y, Ha Y, Kim YS. Relationship between pulmonary function and bone mineral density in the Korean National Health and Nutrition Examination Survey. Korean J Intern Med 2016; 31:899-909. [PMID: 27604798 PMCID: PMC5016283 DOI: 10.3904/kjim.2015.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/20/2014] [Accepted: 01/06/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Osteoporosis is common in chronic obstructive pulmonary disease (COPD) patients. The relationship between osteoporosis and COPD has been primarily reported in patients with moderate to severe COPD, but there is no report in the general population. The aim of this study is to investigate the relationship between bone mineral density (BMD) and lung function in the general Korean population. METHODS This study was based on data acquired from the Fourth and Fifth Korea National Health and Nutrition Examination Surveys (KNHANES IV and V), conducted from 2008 to 2010. The study population included 4,501 subjects (aged ≥ 50 years) who underwent both spirometry and BMD. The study populations were divided into two groups by sex to correct for the effects of gender on BMD. All female participants were postmenopausal women. RESULTS The BMD values of the femur neck, total femur, and L-spine tended to decrease with degree of airflow limitation in both genders. To correct confounding factors, data were analyzed and adjusted for age, body mass index, fat free mass index, body fat percentage, smoking amount, parathyroid hormone levels, daily calcium and phosphorus intake, and alkaline phosphatase (ALP) levels. While the BMD of the femur neck, total femur, and L-spine was reduced significantly as age and ALP increased, the correlation between airway obstruction and BMD of all regions disappeared in both genders. CONCLUSIONS In the general population aged 50 years and older, diminution of BMD is not associated with airway obstruction. Further investigation along other factors is needed to determine the possible role of pulmonary function and BMD.
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Affiliation(s)
- In Seon Lee
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Leem
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Lee
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Young Sam Kim, M.D. Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1971 Fax: +82-2-393-6884 E-mail:
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Lee PH, Kok VC, Chou PL, Ku MC, Chen YC, Horng JT. Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study. PeerJ 2016; 4:e2634. [PMID: 27812429 PMCID: PMC5088616 DOI: 10.7717/peerj.2634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/30/2016] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Osteoporosis is becoming an impending epidemic in the Asia-Pacific region. The association between risk of osteoporotic fracture (OTPF) and chronic obstructive pulmonary disease (COPD) in East Asian patients is yet to be fully examined. We conducted a nationwide population-based retrospective cohort study of 98,700 patients aged ≥50 years with or without COPD using a national administrative claims dataset. MATERIALS AND METHODS The patients were divided into COPD and comparison groups comprising 19,740 and 78,960 patients, respectively. The groups were 1 to 4 matched for age, gender, index date, diabetes mellitus, pre-existing osteoporosis and chronic kidney disease. Information such as the geographic area where southern part represented more sunshine exposure, smoking-related diagnoses, alcohol use disorder, whether there was regular use of inhaled corticosteroids and oral corticosteroids, vitamin D prescriptions, Charlson-Deyo comorbidity index score, and other relevant medical comorbidities were extracted for analysis. They were followed up until OTPF or the end of the year 2013. The outcome measure was an osteoporotic vertebral fracture and other long-bone fractures. A multivariate Cox model was constructed to derive adjusted hazard ratios (aHR) for OTPF with corresponding 95% confidence intervals (CI) after controlling for age, sex, insurance premium category, vitamin D prescription, osteoporosis, and coronary heart disease (CHD). Kaplan-Meier curves of the probability of OTPF-free survival for each cohort were compared using the log-rank test. Patients with OTPF during the first follow-up year were excluded from the overall risk calculation. Contributing factors to the increased risk of OTPF in COPD patients were examined in a sensitivity analysis. RESULTS After a total follow-up of 68,743 patient-years for the COPD group and 278,051 patient-years for the matched comparison group, the HR for OTPF was 1.24 (95% CI [1.02-1.51]; P = 0.0322) in COPD patients. The aHR was increased by 30% for vertebral OTPF (aHR = 1.297, 95% CI [1.020-1.649]; P = 0.0339). Differential lag time sensitivity analysis revealed a progressively elevated risk up to 8-fold increase in women (aHR = 8.0 (95% CI [1.81-35.4]; P < 0.01)) during the fifth follow-up year. COPD patients with pre-existing osteoporosis or given vitamin D prescription harbor a sustained increased risk up to the 5th (aHR, 4.1; 95% CI [1.61-10.35]) and third (aHR, 2.97; 95% CI [1.48-5.97]) follow-up year, respectively. CONCLUSIONS Our nationwide population-based cohort study demonstrates that East Asian COPD patients aged 50 and beyond do harbor a modestly increased risk for osteoporotic vertebral fractures particularly for those who are female, have pre-existing osteoporosis or require vitamin D prescription.
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Affiliation(s)
- Ping-Hsueh Lee
- Department of Geriatric Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
| | - Victor C. Kok
- KTGH Cancer Center, Kuang Tien General Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Po-Liang Chou
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
| | - Ming-Chang Ku
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
- Department of Diagnostic Radiology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yu-Ching Chen
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Jorng-Tzong Horng
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
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Lee K. Is FEV(1) an indicator of low bone mineral density in adults? The Fifth Korea National Health and Nutrition Examination Survey. J Bone Miner Metab 2015; 33:335-41. [PMID: 24849737 DOI: 10.1007/s00774-014-0595-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/09/2014] [Indexed: 12/01/2022]
Abstract
The association between forced expiratory volume in 1 s (FEV1) and bone mineral density (BMD) is heterogeneous in population-based studies. This study aimed to investigate this relationship when sex and menopausal status in women, BMD sites, and anthropometric measures were taken into account. In 3,975 Koreans (1,783 men, 662 premenopausal women, 1,530 postmenopausal women, aged 40-91 years) participating in the Fifth Korea National Health and Nutrition Examination Survey in 2010-2011, this relationship for BMD at femur (total and neck) and lumbar spine was examined in each subgroup after adjusting for age, smoking, and alcohol habit, physical activity, calcium intake, osteoporosis treatment, and anthropometry (weight and height, height and BMI, or height, lean mass, and fat mass). Airflow limitation (FEV(1) ≥ 80, 50-80, and < 50% of predicted FEV(1)) and lower vs. higher BMD using BMD values at site and subgroup-specific 10 percentile of BMD distribution were defined. In multiple regression analysis, the association between FEV(1) and BMD was significant in premenopausal women [B = 0.027-0.031 (total femur), 0.035-0.037 (femoral neck), p < 0.05] but not in other subgroups. In logistic regression analysis, severe airflow limitation was associated with lower BMD in postmenopausal women [OR 2.21-2.37 (total femur), 2.25 (femoral neck), p < 0.05] and premenopausal women (OR 2.14, 95% CI, 1.01-4.50 for femoral neck in height and body composition-adjusted model), but not exhibit these associations in men. As a whole, the associations with spine BMD were non-significant. Therefore, the associations were sex-, menopausal status in women-, and BMD site-specific, while the types of anthropometry had similar effects on the associations.
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Affiliation(s)
- Kayoung Lee
- Department of Family Medicine, Busan Paik Hospital, College of Medicine, Inje University, 633-165 Kaegum-dong, Busan Jin-Gu, Busan, 614-735, South Korea,
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Cauley JA, Blackwell TL, Redline S, Ensrud KE, Ancoli-Israel S, Fink HA, Orwoll ES, Stone KL. Hypoxia during sleep and the risk of falls and fractures in older men: the Osteoporotic Fractures in Men Sleep Study. J Am Geriatr Soc 2014; 62:1853-9. [PMID: 25283237 PMCID: PMC4206605 DOI: 10.1111/jgs.13069] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To test the hypothesis that low arterial oxygen saturation during sleep is associated with a greater risk of falls and fractures. DESIGN Prospective cohort study. SETTING Six U.S. clinical centers. PARTICIPANTS Men aged 67 and older (N = 2,911). MEASUREMENTS The primary exposure measure was percentage of sleep time with arterial oxygen saturation less than 90% measured using polysomnography. The main outcome measures were incident falls within 1 year and incident nonspine fractures over an average follow-up of 6.8 years. RESULTS Men with 10% or more of sleep time at an arterial oxygen saturation of less than 90% were older, reported more comorbidities, had poorer physical function, and were more likely to have sleep disordered breathing than men with less than 10% sleep time at an arterial oxygen saturation of less than 90%. After multivariate adjustment, men with 10% or more of sleep time with arterial oxygen saturation of less than 90% had a greater risk of having one or more falls (relative risk (RR) = 1.25, 95% confidence interval (CI) = 1.04-1.51) and two or more falls (RR = 1.43, 95% CI = 1.06-1.92) than those with less than 10% of sleep time with less than 90% arterial oxygen saturation. Men with greater percentage of sleep time with arterial oxygen saturation less than 90% had a 30% to 40% greater risk of nonspine fracture than those with normal nocturnal oxygen saturation in models adjusting for sleep disordered breathing. CONCLUSION Hypoxia during sleep may be a risk factor for falls and fractures in older men. Interventions aimed at decreasing nocturnal hypoxia may decrease falls and fractures.
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16
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Looker AC. Relationship between femur neck bone mineral density and prevalent chronic obstructive pulmonary disease (COPD) or COPD mortality in older non-Hispanic white adults from NHANES III. Osteoporos Int 2014; 25:1043-52. [PMID: 24435272 DOI: 10.1007/s00198-013-2601-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/10/2013] [Indexed: 11/26/2022]
Abstract
SUMMARY The relationship between femur neck bone mineral density (FNBMD), prevalent COPD, and COPD mortality was examined in older non-Hispanic white adults from NHANES III. FNBMD was significantly related to prevalent COPD and COPD mortality before and after adjusting for shared risk factors. INTRODUCTION Bone mineral density (BMD) has been linked to chronic obstructive pulmonary disease (COPD), but little is known about its relationship with COPD mortality. The present study examined the relationship between FNBMD, prevalent COPD, and COPD mortality in older non-Hispanic white adults from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). METHODS COPD status at baseline was defined by self-reported physician's diagnosis and by airway obstruction based on spirometry measurements in 3,275 non-Hispanic whites aged 50 years and older. COPD mortality cases were identified using linked mortality records obtained through 2006. FNBMD was measured by dual-energy x-ray absorptiometry. Multiple regression was used to examine the baseline relationship between COPD and FNBMD. Cox proportional hazards models were used to estimate the hazards ratio (HR) for COPD mortality by FNBMD. RESULTS Twelve percent self-reported a physician's diagnosis of COPD, 23 % had mild or moderate airway obstruction, and 9 % had severe or very severe airway obstruction. There were 180 COPD mortality cases in the sample. FNBMD was significantly lower in those with self-reported COPD diagnosis or airway obstruction before and after adjusting for shared risk factors (p < 0.05). COPD mortality risk was significantly increased for each standard deviation decline in FNBMD before (by 68 %) and after (by 26-38 %) adjusting for shared risk factors. CONCLUSIONS Low FNBMD was associated with both baseline COPD and future COPD mortality. Shared risk factors appeared to explain some, but not all, of these relationships.
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Affiliation(s)
- A C Looker
- Centers for Disease Control and Prevention, National Center for Health Statistics, Room 4310, 3311 Toledo Rd, Hyattsville, MD, 2078, USA,
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Yamamoto Y, Yoshikawa M, Tomoda K, Fujita Y, Yamauchi M, Fukuoka A, Tamaki S, Koyama N, Kimura H. Distribution of bone mineral content is associated with body weight and exercise capacity in patients with chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2013; 87:158-64. [PMID: 24334752 DOI: 10.1159/000355095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although low bone mineral density is highly prevalent in patients with chronic obstructive pulmonary disease (COPD), the distribution of the reduced bone mass has not been fully elucidated. OBJECTIVES To determine regional bone mass loss in patients with COPD and investigate whether the change in distribution may be associated with body weight loss and functional capacity. METHODS Body mass index (BMI) was assessed, and height squared indices were derived for the bone mineral content index (BMCI) of the arms, legs and trunk by dual-energy X-ray absorptiometry in 45 male patients with COPD and 12 age- and sex-matched control subjects. Pulmonary function tests were performed, and maximal oxygen uptake (VO2max) was measured. RESULTS The BMCI was lower in the total bone, legs and trunk of patients with COPD than in control subjects, although the BMCI in the arms was similar between the groups. BMI correlated significantly with the BMCI in all 3 segments. Bone mineral content (BMC) in the trunk, expressed as a percentage of total BMC (BMC trunk/total BMC), correlated significantly with BMI. The BMCI in the trunk was closely related with VO2max but not with airflow limitation. CONCLUSIONS There was a regional difference in BMC reduction, but a predominant reduction of bone mass in the trunk was not associated with the severity of airflow limitation but rather with body weight loss and exercise intolerance. These data suggest that body weight loss and exercise intolerance are important risk factors for vertebral fracture in patients with COPD.
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Affiliation(s)
- Yoshifumi Yamamoto
- Second Department of Internal Medicine, Nara Medical University, Nara, Japan
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Dennison EM, Dhanwal DK, Shaheen SO, Azagra R, Reading I, Jameson KA, Sayer AA, Cooper C. Is lung function associated with bone mineral density? Results from the Hertfordshire Cohort Study. Arch Osteoporos 2013; 8:115. [PMID: 23322029 PMCID: PMC3622903 DOI: 10.1007/s11657-012-0115-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 11/14/2012] [Indexed: 02/03/2023]
Abstract
UNLABELLED Given limited information available regarding associations between lung function and bone mineral density among healthy subjects, we undertook these analyses in the Hertfordshire Cohort Study. Forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC) and FEV(1)/FVC were not associated with bone mineral density at any site; associations with bone mineral content were removed by adjustment for body size. PURPOSE There is limited information available regarding the association between lung function and bone mineral density among healthy elderly subjects. We addressed this issue in the Hertfordshire Cohort Study. METHODS From the above cohort, 985 subjects (496 men and 489 women) aged 60-72 years were recruited. All subjects underwent bone density measurements using dual energy X-ray absorptiometry and lung function tests using standardised spirometry. Chronic obstructive pulmonary disease (COPD) was defined as a FEV(1)/FVC ratio <lower limit of normal, calculated using separate equations for men and women. RESULTS Measures of lung function (FEV(1), FVC and FEV(1)/FVC) were not associated with bone mineral density at the lumbar spine, femoral neck and total hip in men or women; associations with bone mineral content and bone area were removed by adjustment for body size and lifestyle confounders. In this cohort, there were no associations observed between COPD and any measure of bone mass. CONCLUSIONS There was no association between lung function and bone mass in this community dwelling cohort after adjustment for body size and other confounders.
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Affiliation(s)
- EM Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
,Victoria University, PO Box 600, Wellington 6140, New Zealand
| | - DK Dhanwal
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - SO Shaheen
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, London E1 2AT, UK
| | - R Azagra
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
,EAP Badia del Valles ICS), IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Ps Vall d’ Hebron 119, 08135 Barcelona, Spain
| | - I Reading
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - KA Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - AA Sayer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
,Botnar Research Centre, Institute of Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
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Sinden NJ, Stockley RA. Chronic obstructive pulmonary disease: an update of treatment related to frequently associated comorbidities. Ther Adv Chronic Dis 2012; 1:43-57. [PMID: 23251728 DOI: 10.1177/2040622310370631] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with a pulmonary inflammatory response to inhaled substances, and individuals with COPD often have raised levels of several circulating inflammatory markers indicating the presence of systemic inflammation. Recently, there has been increasing interest in comorbidities associated with COPD such as skeletal muscle dysfunction, cardiovascular disease, osteoporosis, diabetes and lung cancer. These conditions are associated with a similar inflammation-based patho-physiology to COPD, and may represent a lung inflammatory 'overspill' to distant organs. Cardiovascular disease is a significant cause of mortality in COPD, and the concepts of an inflammatory link raise the possibility that treatment for one organ may show benefits to comorbidities in other organs. When considering treatment of COPD and its comorbidities, one approach is to target the pulmonary inflammation and hence reduce any 'overspill' effect of inflammatory mediators systemically as suggested by response to inhaled corticosteroids. Alternatively, treatment targeted towards comorbid organs may alter features of pulmonary disease as statins, angiotensin-converting enzyme (ACE) inhibitors and peroxisome proliferator-activated receptor (PPAR) agonists may have beneficial effects on COPD by reducing exacerbations and mortality. Newer anti-inflammatory treatments, such as phosphodiesterase 4 (PDE4), nuclear factor(NF)-kB, and p38 mitogen-activated protein kinase (MAPK) inhibitors, are given systemically and may confer benefits to both COPD and its comorbidities. With common inflammatory pathways it might be expected that successful anti-inflammatory therapy in one organ may also influence others. In this review we explore the concepts of systemic inflammation in COPD and current evidence for treatment of its related comorbidities.
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Affiliation(s)
- Nicola J Sinden
- Nicola J. Sinden, MBChB(Honours), MRCP (UK) University Hospital Birmingham NHS Foundation Trust - Respiratory Medicine, Birmingham, UK
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Dennison EM, Compston JE, Flahive J, Siris ES, Gehlbach SH, Adachi JD, Boonen S, Chapurlat R, Díez-Pérez A, Anderson FA, Hooven FH, LaCroix AZ, Lindsay R, Netelenbos JC, Pfeilschifter J, Rossini M, Roux C, Saag KG, Sambrook P, Silverman S, Watts NB, Greenspan SL, Premaor M, Cooper C. Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone 2012; 50:1288-93. [PMID: 22426498 PMCID: PMC4886309 DOI: 10.1016/j.bone.2012.02.639] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/03/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX. MATERIALS AND METHODS We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates. RESULTS Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson's disease (age-adjusted hazard ratio [HR]: 2.2; 95% CI: 1.6-3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease. CONCLUSION Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson's disease carried a particularly high risk of fracture; and increasing co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.
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Affiliation(s)
- Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
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Sim YS, Lee JH, Kim Y, Chang JH. Association of bone mineral density with airway obstruction and emphysema. Tuberc Respir Dis (Seoul) 2012; 72:310-7. [PMID: 23227071 PMCID: PMC3510281 DOI: 10.4046/trd.2012.72.3.310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 01/02/2012] [Accepted: 01/30/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Airway obstruction and the extent of emphysema are reported to be responsible for reduced bone mineral density (BMD). Corresponding to different phenotypes of a pulmonary disease, different severity in extra pulmonary features may exist. We compared BMDs of subjects with or without airway obstruction and/or emphysema and investigated the relationships among BMD, the severity of airway obstruction, and the extent of emphysema. METHODS Using a university hospital database, we reviewed patients over 40 years old who performed spirometry, computed tomography of chest, and measurement of BMD of the lumbar (L) spine. According to the presence or absence of airway obstruction and/or emphysema, four groups were classified. RESULTS Among a total of 59 subjects, 33 (56%) had osteoporosis. The prevalence of osteoporosis in subjects with no airway obstruction and no emphysema, those with only emphysema, those with only airway obstruction, and those with both airway obstruction and emphysema were 42%, 57%, 64%, and 73%, respectively (p=0.047 by linear-by-linear association). The mean T-scores of BMD of L1 (p=0.032) and L1-4 spines were different among the four groups (p=0.034). Although the T-score of L1 BMD negatively correlated with the extent of emphysema (r=-0.275, p=0.035) and positively with each of body mass index (BMI) (r=0.520, p<0.001), forced expiratory volume in one second (FEV(1)) (r=0.330, p=0.011), FEV(1)/forced vital capacity (r=0.409, p=0.001), and forced expiratory flow at 25~75% of FVC (FEF(25-75%)) (r=0.438, p=0.0001), respectively, multiple linear regression analysis indicated that BMI (p<0.001) and FEF(25-75%) were predictive of BMD (p=0.012). CONCLUSION Low BMI and airway obstruction were strongly associated with reduced bone density rather than the extent of emphysema.
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Affiliation(s)
- Yun Su Sim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
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Morden NE, Sullivan SD, Bartle B, Lee TA. Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures. Osteoporos Int 2011; 22:1855-62. [PMID: 20936402 PMCID: PMC3084349 DOI: 10.1007/s00198-010-1423-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 09/03/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED To advance our understanding of the burden of fractures among men, we studied a group of men at high risk for low bone strength due to lung disease. We found high rates of fractures but low rates of bone density testing that could predict fracture before it occurs. INTRODUCTION To advance understanding of the burden of fragility fractures and attention to bone health among men with chronic obstructive lung disease (COPD), we quantified rates of fragility fracture, bone density testing, and anti-resorptive treatment and calculated the number needed to screen (NNS) to prevent one hip fracture in a cohort of men with COPD. METHODS Veterans Administration (VA) and VA-Medicare administrative data permitted a retrospective cohort study of 87,360 men aged 50 and older, newly diagnosed with COPD between 1999 and 2003. Logistic regression models including patient characteristics, morbidities, and medication use assessed the effect of covariates on fracture and probability of testing or treatment. RESULTS Mean age was 66.8. Hip and wrist fracture rates were 3.99 and 1.31 per 1,000 person years, respectively. Mean follow-up was 2.67 years; 4.4% underwent bone densitometry; 2.8% filled anti-resorptive prescriptions. Age, white race/ethnicity, more COPD exacerbations, barbiturate use, and anti-Parkinson's drug use were significantly associated with fracture. Age, and systemic corticosteroids were most significantly associated with testing or treatment. Based on published adherence and treatment effects, the cohort's calculated NNS to prevent one hip fracture is 432. CONCLUSIONS Fracture rate was high and testing and treatment uncommon. The NNS of 432 to prevent one hip fracture is smaller than 731, the NNS for women aged 65-69 for whom universal screening is recommended. Attention to the bone health of this population is warranted. Future research must determine how testing and treatment impact overall quality of life and mortality of men with COPD.
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Affiliation(s)
- N E Morden
- The Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA.
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Dam TT, Harrison S, Fink HA, Ramsdell J, Barrett-Connor E. Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma. Osteoporos Int 2010; 21:1341-9. [PMID: 19816753 PMCID: PMC2895883 DOI: 10.1007/s00198-009-1076-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 08/26/2009] [Indexed: 11/23/2022]
Abstract
SUMMARY In 5,541 community dwelling men, chronic obstructive pulmonary disease, or asthma was associated with lower bone mineral density (BMD) at the spine and total hip and an increased risk of vertebral and nonvertebral fractures independent of age, body mass index, and smoking. Men prescribed with corticosteroids had the lowest BMD. INTRODUCTION It is unclear whether chronic obstructive pulmonary disease (COPD) is independently associated with BMD and fractures. METHODS In 5,541 men from the Osteoporotic Fractures in Men Study, history of COPD or asthma, current treatment with corticosteroids, BMD, bone loss after 4.5 years and fractures were ascertained. RESULTS Seven hundred fourteen (13%) men reported COPD or asthma, of which 103 were prescribed an oral steroid and 177 an inhaled steroid. Independent of confounders, men prescribed corticosteroids for COPD or asthma had the lowest BMD and a 2-fold increased risk of vertebral osteoporosis compared to men with no history of COPD or asthma (OR 2.13, 95% CI (confidence interval) 1.15-3.93 oral steroids; OR 2.05, 95% CI 1.27-3.31 inhaled steroids). During follow-up, BMD increased at the spine, but there was no difference in bone loss at the hip. However, men with COPD or asthma had a 2.6- and 1.4-fold increased risk of vertebral and nonvertebral fractures, respectively. CONCLUSION Chronic obstructive pulmonary disease or asthma was associated with lower BMD at the spine and hip and increased risk of vertebral and nonvertebral fractures independent of age, clinic site, BMI, and smoking. A history of COPD or asthma may be a useful clinical risk factor to identify patients with osteoporosis.
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Affiliation(s)
- T-T Dam
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
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Franco CB, Paz-Filho G, Gomes PE, Nascimento VB, Kulak CAM, Boguszewski CL, Borba VZC. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int 2009; 20:1881-7. [PMID: 19300892 DOI: 10.1007/s00198-009-0890-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 01/21/2009] [Indexed: 10/21/2022]
Abstract
UNLABELLED We did a cross-sectional analysis of chronic pulmonary obstructive disease (COPD) patients without chronic use of systemic glucocorticoids (CUG). Osteoporosis was found in 51% and bone mineral density (BMD) was correlated with severity of disease. Low levels of vitamin D were found in 94%. All COPD patients may benefit from vitamin D supplementation and screening for low BMD. INTRODUCTION Patients with chronic pulmonary obstructive disease have low bone mineral density, caused by chronic use of systemic glucocorticoids and hypovitaminosis D. However, patients without CUG may also have low BMD. METHODS We performed a cross-sectional analysis in 49 patients (21 men, 28 postmenopausal women), with COPD without CUG, from Brazil (25 degrees 25' S). Several markers of bone metabolism were measured, plus BMD. Osteoporosis risk factors and history of fractures were investigated. Respiratory function was assessed by venous gasometry, spirometry, and oximetry. BMD results were compared to those of 40 healthy non-smokers controls. RESULTS COPD patients had lower BMD at all sites (p < 0.01). Osteoporosis was observed in 51%. BMD independently correlated with stage of disease (lumbar spine, R = 0.38, p = 0.01; total femur, R = 0.36, p = 0.01; femoral neck, R = 0.40, p < 0.01). Ninety-four percent had low levels of vitamin D (<30 ng/mL) and 67% had secondary hyperparathyroidism. Vitamin D was correlated with oxygen saturation (R = 0.36, p = 0.01), with lower levels in those with saturation <88% (p = 0.01). CONCLUSION Patients with COPD without CUG have increased risk for osteoporosis. Such patients have hypovitaminosis D, which is correlated with the severity of disease. Screening for low BMD and vitamin D supplementation may be warranted to all COPD patients.
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Affiliation(s)
- C B Franco
- Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná (SEMPR), Curitiba, Brazil, CEP: 80030-110
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Langhammer A, Forsmo S, Syversen U. Long-term therapy in COPD: any evidence of adverse effect on bone? Int J Chron Obstruct Pulmon Dis 2009; 4:365-80. [PMID: 19888355 PMCID: PMC2771707 DOI: 10.2147/copd.s4797] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with COPD have high risk for osteoporosis and fractures. Hip and vertebral fractures might impair mobility, and vertebral fractures further reduce lung function. This review discusses the evidence of bone loss due to medical treatment opposed to disease severity and risk factors for COPD, and therapeutic options for the prevention and treatment of osteoporosis in these patients. A review of the English-language literature was conducted using the MEDLINE database until June 2009. Currently used bronchodilators probably lack adverse effect on bone. Oral corticosteroids (OCS) increase bone resorption and decrease bone formation in a dose response relationship, but the fracture risk is increased more than reflected by bone densitometry. Inhaled corticosteroids (ICS) have been associated with both increased bone loss and fracture risk. This might be a result of confounding by disease severity, but high doses of ICS have similar effects as equipotent doses of OCS. The life-style factors should be modified, use of regular OCS avoided and use of ICS restricted to those with evidenced effect and probably kept at moderate doses. The health care should actively reveal risk factors, include bone densitometry in fracture risk evaluation, and give adequate prevention and treatment for osteoporosis.
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Affiliation(s)
- Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Verdal, Norway.
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