Background Patients with chronic obstructive pulmonary disease (COPD) have a high risk of osteoporosis and fractures. We reported 27% of vertebral fractures in COPD male patients with normal bone mineral density (BMD)1. TBS has been described as an index of bone microarquitecture, and could be a new assessment tool to detect bone quality impairment.
Objectives Analysis of TBS in a sub-cohort of male patients with COPD and its possible association with BMD,corticoid use, COPD severity or vertebral fractures.
Methods Male patients, older than 50 years, with COPD were included.Exclusion criteria: Other concomitant pulmonary disease, rheumatologic and/or vertebral disease that may lead to missinterpretation of BMD by DXA.
Exclusion criteria: Other concomitant pulmonary disease,rheumatologic and/or vertebral disease that may lead to missinterpretation of BMD by DXA. BMD wasdetermined by dual-energy X-ray absorptiometry (DXA) at lumbar spine and proximal femur. Vertebralfractures were assessed by thoracic and lumbar X-ray. Corticosteroid use in the previous five years andnumber of hospitalizations were recorded in all patients.
Results We included 98 patients. Mean age 67.8±7.5 years. 38% patients had a mild pulmonar disease, 39% moderate and 23% had a severe disease ((FEV1/FVC<30%). 29 patients (30%) had morphometric vertebral fractures. Mean BMD T-score at lumbar spine -1.67±1.55, at femoral neck -1.81±1.04, and al total hip -1.31±1.14. Mean TBS was 1.035±0,135 (T-score -2.85±1.18). TBS was lower in fractured patients (T -2.59±1.16 vs -2.34±1.22; p=NS). According to COPD severity TBS was lower in patients with modereate disease (T-2.57±1.34) and severe disease (T -2.54±1.34) than in patients with mild disease (T -2.19±1.32), although without reaching significant differences. We didn't find any significant assotiation between TBS and corticosteroid use.
98 patients were included. Mean age 67.8±7.5 years. 41% of patients had mild lung disease and 22% had severe disease (FEV1/FVC <30%). 58% of patients had received corticosteroid therapy in the past 5 years. 29 patients (30%) presented morphometric vertebral fractures. BMD values were: lumbar spine T-score -1.67±1.55, femoral neck T-score -1.81± 1.04, total hip T-score -1.31±1.14. 91% of patients had a degraded or very degraded microarchitecture according to TBS, with a mean value of 1.035±0.135 (T-score -2.85±1.18). Microarchitecture (TBS) was more deteriorated in fractured patients (2.59±1.16 vs T - 2.34 ±1.22; p = NS). TBS was lower in patients with moderate pulmonary disease (2.57±1.34 T) and severe disease (T -2.54±1.34) than in patients with mild disease (T - 2.19±1.32, p<0.05). Both, use of corticosteroids and high cumulative dose were associated with lower TBS (p=0.002 and p=0.015 respectively).
Conclusions TBS is severely impaired in male patients with chronic obstructive pulmonary disease, especially in patients with moderate and severe pulmonary disease and those who have received corticosteroids. Although patients with vertebral fractures have a lower value of TBS, this technique does not detect many cases with fracture.
Casado E, et al. JBMR 2007; 22 (S1): S202
Disclosure of Interest None declared