Reduced bone density and vertebral fractures in smokers. Men and COPD patients at increased risk

COPDGene Investigators

Research output: Contribution to journalArticle

50 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)648-656
Number of pages9
JournalAnnals of the American Thoracic Society
Volume12
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Bone Density
Chronic Obstructive Pulmonary Disease
Smoking
Osteoporosis
Tomography
Young Adult
Body Mass Index
History
Steroids
Bone Fractures
Photon Absorptiometry
Emphysema
Glucocorticoids
Lung Diseases
Reference Values
Thorax
Guidelines

Keywords

  • COPD
  • Low bone density
  • Quantitative computed tomography
  • Smoking
  • Vertebral fractures

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Reduced bone density and vertebral fractures in smokers. Men and COPD patients at increased risk. / COPDGene Investigators.

In: Annals of the American Thoracic Society, Vol. 12, No. 5, 01.05.2015, p. 648-656.

Research output: Contribution to journalArticle

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title = "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.",
keywords = "COPD, Low bone density, Quantitative computed tomography, Smoking, Vertebral fractures",
author = "{COPDGene Investigators} and Jaramillo, {Joshua D.} and Carla Wilson and Stinson, {Douglas J.} and Lynch, {David A.} and Bowler, {Russell P.} and Sharon Lutz and Bon, {Jessica M.} and Ben Arnold and McDonald, {Merry Lynn N} and Washko, {George R.} and Wan, {Emily S.} and DeMeo, {Dawn L.} and Foreman, {Marilyn G.} and Xavier Soler and Lindsay, {Sarah E.} and Lane, {Nancy E} and Genant, {Harry K.} and Silverman, {Edwin K.} and Hokanson, {John E.} and Make, {Barry J.} and Crapo, {James D.} and Regan, {Elizabeth A.}",
year = "2015",
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T1 - Reduced bone density and vertebral fractures in smokers. Men and COPD patients at increased risk

AU - COPDGene Investigators

AU - Jaramillo, Joshua D.

AU - Wilson, Carla

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.

PY - 2015/5/1

Y1 - 2015/5/1

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.

AB - 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.

KW - COPD

KW - Low bone density

KW - Quantitative computed tomography

KW - Smoking

KW - Vertebral fractures

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U2 - 10.1513/AnnalsATS.201412-591OC

DO - 10.1513/AnnalsATS.201412-591OC

M3 - Article

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EP - 656

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

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