What community measurements can be used to predict bone disease in patients with COPD?

• Published in: Respiratory medicine Vol. 102; no. 5; pp. 651 - 657
• Main Authors: Bolton, C.E, Cannings-John, R, Edwards, P.H, Ionescu, A.A, Evans, W.D, Pettit, R.J, Faulkner, T.A, Stone, M.D, Shale, D.J
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.05.2008; Elsevier; Elsevier Limited
• Subjects: Absorptiometry, Photon; Aged; Anthropometry; Biological and medical sciences; Body composition; Body Mass Index; Body Weight; Bone Density; Bones; Chronic obstructive pulmonary disease, asthma; COPD; Diseases of the osteoarticular system; Female; Forearm - anatomy & histology; Humans; Male; Medical sciences; Middle Aged; Older people; Osteoporosis; Osteoporosis - complications; Osteoporosis - diagnosis; Osteoporosis. Osteomalacia. Paget disease; Pneumology; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary/Respiratory; ROC Curve; Skinfold Thickness; Spirometry; United Kingdom > UK; Osteoporosis; Anthropometry; Body composition; COPD; Human; Lung disease; Respiratory disease; Use; Diseases of the osteoarticular system; Prediction; Chronic; Bronchus disease; Chronic obstructive pulmonary disease; Obstructive pulmonary disease; Community; Pneumology
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2007.12.027

Summary Background Osteoporosis is common in patients with COPD. Previously we have reported that loss of fat-free mass (FFM), measured by dual X-ray absorptiometry (DXA) is associated with loss of bone mineral density (BMD). In addition, in patients with a low body mass index (BMI) and a low FFM, all had evidence of bone thinning, 50% having osteopenia and 50% osteoporosis. We explored the utility of different anthropometric measures in detecting osteoporosis in a community-based COPD population. Methods Patients with confirmed COPD and not on long-term oral corticosteroids ( n =58) performed spirometry. They underwent nutritional assessment by skinfold anthropometry, midarm circumference, calculation of both % ideal body weight (IBW) and BMI. All had DXA assessment of BMD. Results A total of 58 COPD patients had anthropometric measurements taken, with a mean age of 66.8 (SD 8.7) years, 31 (58%) were male, with a forced expiratory volume in 1 s (FEV1 ) of 54.17 (20.18)% predicted. Osteoporosis was present at either the hip or lumbar region in 14 patients (24%). The useful anthropometric measurements identifying those with osteoporosis were both % IBW and BMI. The adjusted odds ratio for %IBW was 0.93 (95% confidence interval (CI) 0.87, 0.99), p =0.016 and for BMI: 0.79 (0.64–0.98), p =0.03. The receiver operating characteristics (ROC) score for both was 0.88, indicating a good fit. Conclusion Osteoporosis is common, even in patients with mild airways obstruction. Nutritional assessment, incorporating a calculation of their BMI or %IBW may confer an additional benefit in detecting those at risk of osteoporosis and guide referral for BMD measurement.