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Exploring the Association Between Emphysema Phenotypes and Low Bone Mineral Density in Smokers with and without COPD

Authors González J, Rivera-Ortega P, Rodríguez-Fraile M, Restituto P, Colina I, Calleja MD, Alcaide AB, Campo A, Bertó J, Seijo L, Pérez-Warnisher MT, Zulueta JJ, Varo N, de-Torres JP

Received 12 April 2020

Accepted for publication 2 July 2020

Published 27 July 2020 Volume 2020:15 Pages 1823—1829


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Jessica González, 1 Pilar Rivera-Ortega, 2 Macarena Rodríguez-Fraile, 3 Patricia Restituto, 4 Inmaculada Colina, 5 María de los Desamparados Calleja, 6 Ana B Alcaide, 2 Aránzazu Campo, 2 Juan Bertó, 2 Luis Seijo, 7 Maria Teresa Pérez-Warnisher, 7 Javier J Zulueta, 2 Nerea Varo, 4 Juan P de-Torres 8

1Pulmonary Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain; 2Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain; 3Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; 4Biochemistry Department, Clínica Universitaria de Navarra, Pamplona, Spain; 5Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain; 6Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; 7Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain; 8Respirology Division, Queen’s University, Kingston, ON, Canada

Correspondence: Jessica González
Pulmonary department, Hospital Universitari Arnau de Vilanova, Lleida, Spain

Rationale: Emphysema and osteoporosis are tobacco-related diseases. Many studies have shown that emphysema is a strong and independent predictor of low bone mineral density (BMD) in smokers; however, none of them explored its association with different emphysema subtypes.
Objective: To explore the association between the different emphysema subtypes and the presence of low bone mineral density in a population of active or former smokers with and without chronic obstructive pulmonary disease (COPD).
Methods: One hundred and fifty-three active and former smokers from a pulmonary clinic completed clinical questionnaires, pulmonary function tests, a low-dose chest computed tomography (LDCT) and a dual-energy absorptiometry (DXA) scans. Subjects were classified as having normal BMD or low BMD (osteopenia or osteoporosis). Emphysema was classified visually for its subtype and severity. Logistic regression analysis explored the relationship between the different emphysema subtypes and the presence of low BMD adjusting for other important factors.
Results: Seventy-five percent of the patients had low BMD (78 had osteopenia and 37 had osteoporosis). Emphysema was more frequent (66.1 vs 26.3%, p=< 0.001) and severe in those with low BMD. Multivariable analysis adjusting for other significant cofactors (age, sex, FEV 1, and severity of emphysema) showed that BMI (OR=0.91, 95% CI: 0.76– 0.92) and centrilobular emphysema (OR=26.19, 95% CI: 1.71 to 399.44) were associated with low BMD.
Conclusion: Low BMD is highly prevalent in current and former smokers. BMI and centrilobular emphysema are strong and independent predictors of its presence, which suggests that they should be considered when evaluating smokers at risk for low BMD.

Keywords: emphysema, COPD, low bone mineral density, osteopenia, osteoporosis; smokers

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