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Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk.

Abstract

RATIONALE

Former smoking history and chronic obstructive pulmonary disease (COPD) are potential risk factors for osteoporosis and fractures. Under existing guidelines for osteoporosis screening, women are included but men are not, and only current smoking is considered.

OBJECTIVES

To demonstrate the impact of COPD and smoking history on the risk of osteoporosis and vertebral fracture in men and women.

METHODS

Characteristics of participants with low volumetric bone mineral density (vBMD) were identified and related to COPD and other risk factors. We tested associations of sex and COPD with both vBMD and fractures adjusting for age, race, body mass index (BMI), smoking, and glucocorticoid use.

MEASUREMENTS AND MAIN RESULTS

vBMD by calibrated quantitative computed tomography (QCT), visually scored vertebral fractures, and severity of lung disease were determined from chest CT scans of 3,321 current and ex-smokers in the COPDGene study. Low vBMD as a surrogate for osteoporosis was calculated from young adult normal values. Male smokers had a small but significantly greater risk of low vBMD (2.5 SD below young adult mean by calibrated QCT) and more fractures than female smokers. Low vBMD was present in 58% of all subjects, was more frequent in those with worse COPD, and rose to 84% among subjects with very severe COPD. Vertebral fractures were present in 37% of all subjects and were associated with lower vBMD at each Global Initiative for Chronic Obstructive Lung Disease stage of severity. Vertebral fractures were most common in the midthoracic region. COPD and especially emphysema were associated with both low vBMD and vertebral fractures after adjustment for steroid use, age, pack-years of smoking, current smoking, and exacerbations. Airway disease was associated with higher bone density after adjustment for other variables. Calibrated QCT identified more subjects with abnormal values than the standard dual-energy X-ray absorptiometry in a subset of subjects and correlated well with prevalent fractures.

CONCLUSIONS

Male smokers, with or without COPD, have a significant risk of low vBMD and vertebral fractures. COPD was associated with low vBMD after adjusting for race, sex, BMI, smoking, steroid use, exacerbations, and age. Screening for low vBMD by using QCT in men and women who are smokers will increase opportunities to identify and treat osteoporosis in this at-risk population.

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  • Authors+Show Affiliations

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    1 National Jewish Health, Denver, Colorado.

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    Source

    MeSH

    Adult
    Bone Density
    Female
    Humans
    Incidence
    Male
    Middle Aged
    Osteoporosis
    Pulmonary Disease, Chronic Obstructive
    Risk Factors
    Smoking
    Spinal Fractures
    Tomography, X-Ray Computed
    United States

    Pub Type(s)

    Journal Article
    Multicenter Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    25719895

    Citation

    Jaramillo, Joshua D., et al. "Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk." Annals of the American Thoracic Society, vol. 12, no. 5, 2015, pp. 648-56.
    Jaramillo JD, Wilson C, Stinson DS, et al. Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk. Ann Am Thorac Soc. 2015;12(5):648-56.
    Jaramillo, J. D., Wilson, C., Stinson, D. S., Stinson, D. J., Lynch, D. A., Bowler, R. P., ... Regan, E. A. (2015). Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk. Annals of the American Thoracic Society, 12(5), pp. 648-56. doi:10.1513/AnnalsATS.201412-591OC.
    Jaramillo JD, et al. Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk. Ann Am Thorac Soc. 2015;12(5):648-56. PubMed PMID: 25719895.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk. AU - Jaramillo,Joshua D, AU - Wilson,Carla, AU - Stinson,Douglas S, AU - Stinson,Douglas J, AU - Lynch,David A, AU - Bowler,Russell P, AU - Lutz,Sharon, AU - Bon,Jessica M, AU - Arnold,Ben, AU - McDonald,Merry-Lynn N, AU - Washko,George R, AU - Wan,Emily S, AU - DeMeo,Dawn L, AU - Foreman,Marilyn G, AU - Soler,Xavier, AU - Lindsay,Sarah E, AU - Lane,Nancy E, AU - Genant,Harry K, AU - Silverman,Edwin K, AU - Hokanson,John E, AU - Make,Barry J, AU - Crapo,James D, AU - Regan,Elizabeth A, AU - ,, PY - 2015/2/27/entrez PY - 2015/2/27/pubmed PY - 2016/2/3/medline KW - COPD KW - low bone density KW - quantitative computed tomography KW - smoking KW - vertebral fractures SP - 648 EP - 56 JF - Annals of the American Thoracic Society JO - Ann Am Thorac Soc VL - 12 IS - 5 N2 - RATIONALE: Former smoking history and chronic obstructive pulmonary disease (COPD) are potential risk factors for osteoporosis and fractures. Under existing guidelines for osteoporosis screening, women are included but men are not, and only current smoking is considered. OBJECTIVES: To demonstrate the impact of COPD and smoking history on the risk of osteoporosis and vertebral fracture in men and women. METHODS: Characteristics of participants with low volumetric bone mineral density (vBMD) were identified and related to COPD and other risk factors. We tested associations of sex and COPD with both vBMD and fractures adjusting for age, race, body mass index (BMI), smoking, and glucocorticoid use. MEASUREMENTS AND MAIN RESULTS: vBMD by calibrated quantitative computed tomography (QCT), visually scored vertebral fractures, and severity of lung disease were determined from chest CT scans of 3,321 current and ex-smokers in the COPDGene study. Low vBMD as a surrogate for osteoporosis was calculated from young adult normal values. Male smokers had a small but significantly greater risk of low vBMD (2.5 SD below young adult mean by calibrated QCT) and more fractures than female smokers. Low vBMD was present in 58% of all subjects, was more frequent in those with worse COPD, and rose to 84% among subjects with very severe COPD. Vertebral fractures were present in 37% of all subjects and were associated with lower vBMD at each Global Initiative for Chronic Obstructive Lung Disease stage of severity. Vertebral fractures were most common in the midthoracic region. COPD and especially emphysema were associated with both low vBMD and vertebral fractures after adjustment for steroid use, age, pack-years of smoking, current smoking, and exacerbations. Airway disease was associated with higher bone density after adjustment for other variables. Calibrated QCT identified more subjects with abnormal values than the standard dual-energy X-ray absorptiometry in a subset of subjects and correlated well with prevalent fractures. CONCLUSIONS: Male smokers, with or without COPD, have a significant risk of low vBMD and vertebral fractures. COPD was associated with low vBMD after adjusting for race, sex, BMI, smoking, steroid use, exacerbations, and age. Screening for low vBMD by using QCT in men and women who are smokers will increase opportunities to identify and treat osteoporosis in this at-risk population. SN - 2325-6621 UR - https://www.unboundmedicine.com/medline/citation/25719895/Reduced_Bone_Density_and_Vertebral_Fractures_in_Smokers__Men_and_COPD_Patients_at_Increased_Risk_ L2 - http://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201412-591OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -