Chest
Volume 122, Issue 6, December 2002, Pages 1949-1955
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Clinical Investigations: Asthma
A Comparison of Bone Mineral Density in Elderly Female Patients with COPD and Bronchial Asthma

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Background

A recent study has shown that osteoporosis and vertebral fractures are quite common in patients with advanced COPD and showed a significant relationship to the mortality of these patients. These results suggested that management of osteoporosis in advanced COPD is an important intervention. But whether patients with COPD who had never received chronic systemic corticosteroids have a high incidence of osteoporosis and whether these patients require treatment strategies to decrease osteoporotic fracture is not yet known. Furthermore, it is unclear whether there are differences in terms of the degree of osteoporosis between patients with COPD and patients with bronchial asthma.

Objectives

To compare the degree of osteoporosis and bone metabolism markers between elderly women with COPD and those with bronchial asthma who had never received chronic systemic corticosteroids, and to determine the factors influencing bone metabolism in these patients.

Design

Cross-sectional medical survey.

Patients

A total of 44 elderly female patients with COPD (n = 20) or bronchial asthma (n = 24) who had not received chronic systemic corticosteroids were enrolled (mean ± SEM age, 74.6 ± 1.0 years).

Measurements

Total body and lumbar bone mineral density (BMD) were measured by dual-energy x-ray absorptiometry, and the data were compared between the two groups. In addition, the association between bone mass and clinical variables was determined.

Results

When lumbar BMD was expressed as a Z score, the Z scores of patients with COPD were significantly lower than those of patients with bronchial asthma (p < 0.01). The prevalence of osteoporosis was also significantly higher in patients with COPD (50% vs 21%, p < 0.05). In patients with COPD, body mass index was positively correlated with BMD in the lumbar spine (r = 0.55, p = 0.02) and total body (r = 0.49, p = 0.03). Other clinical, biochemical, and anthropometric variables were not correlated with BMD.

Conclusions

In elderly female patients, osteoporosis is more common in cases of COPD than in bronchial asthma, even if these patients had not received long-term systemic corticosteroids. The explanation for the higher prevalence of osteoporosis in COPD is still not known, but preventive strategies to decrease osteoporotic fractures should be added to the management of elderly patients with COPD.

Section snippets

Subjects

Forty-four elderly female Japanese patients with COPD (n = 20) and bronchial asthma (n = 24) regularly followed up at the outpatient clinic of Tokyo Metropolitan Geriatric Medical Center were recruited for this study. The criteria for diagnoses of COPD and bronchial asthma were based on the standards of the American Thoracic Society.7 None of the patients had a history of chronic systemic corticosteroid use, defined as any oral steroids received continuously for > 1 week during the previous 10

Results

Patient characteristics, anthropometric variables, and details of inhaled corticosteroid use are shown in Table 1. All patients with COPD were ex-smokers; however, none of the patients with bronchial asthma had a smoking habit. Compared to patients with bronchial asthma, the patients with COPD were relatively lean and the body mass index (BMI) was significantly smaller (p < 0.04). FEV1 expressed as percentage of predicted value was significantly lower in patients with COPD (p < 0.01), but ADL

Discussion

In this study, we compared the degree of BMD and bone turnover markers between elderly women with COPD and elderly women with bronchial asthma who had not received chronic systemic corticosteroids, and determined the factors that influence bone metabolism in these patients. This study has clearly shown that even in elderly women with COPD who have not received chronic systemic corticosteroids, total body and lumbar BMD was much lower than that in asthmatic patients. The prevalence of

ACKNOWLEDGMENT

The authors thank Dr. Takayuki Hosoi of the Department of Endocrinology, Tokyo Metropolitan Geriatric Medical Center for his helpful discussion.

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  • Cited by (0)

    This study was supported by a grant from the Pollution-Related Health Damage Compensation and Prevention Association of Japan.

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