Comparison of Bone Mineral Density in Elderly Female Patients With COPD and Bronchial Asthma

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Comparison of Bone Mineral Density in Elderly Female Patients With COPD and Bronchial Asthma* Hideki Katsura, MD; and Kozui Kida, MD, FCCP

(CHEST 2000; 117:280S) Abbreviations: BA ⫽ bronchial asthma; BMD ⫽ bone mineral density

recognized that osteoporosis and bone fractures I tareis well common diseases that adversely affect the activities of daily living and quality of life of many elderly patients, especially women. Recent studies have shown that osteoporosis is quite common in patients with end-stage pulmonary diseases, such as cystic fibrosis, and COPD patients who are candidates for lung transplantation. Such studies also have demonstrated an association between chronic systemic corticosteroid use and lower bone mineral density (BMD) in these lung diseases. However, the assertion that COPD patients who have never received systemic corticosteroids have a high incidence of osteoporosis remains controversial. We tested the hypothesis that osteoporosis is worse in elderly COPD compared with bronchial asthma (BA) patients. A total of 44 elderly female patients with mild to moderate COPD (n ⫽ 20) or BA (n ⫽ 24) who had not received any systemic corticosteroids were enrolled. Total body and lumbar BMD were measured by dual energy x-ray absorptiometry along with bone metabolism markers, biochemical, lifestyle, and anthropometric variables, and the data were compared between the two groups. When lumbar BMD was expressed as z score, representing the number of standard deviations between a patient’s BMD and the age- and body weightmatched mean BMD, z scores for patients with COPD were significantly lower than that of patients with BA (1.08 ⫾ 0.34 vs ⫺0.33 ⫾ 0.27; p ⬍ 0.01). In COPD, body mass index was significantly lower than in BA (22.0 ⫾ 0.8 vs 24.6 ⫾ 0.9; p ⬍0.04), and this was positively correlated with BMD (lumbar spine, r ⫽ 0.55, p ⫽ 0.02; total body, r ⫽ 0.49, p ⫽ 0.03). Other biochemical and anthropometric valuables showed no correlation with BMD. We conclude that in elderly female patients, osteoporosis is worse in COPD than in BA. The reason for this difference is uncertain; however, it should be noted that the worsening of osteoporosis debases activities of daily living and increases the chance of acute exacerbation because of suppressed expectoration due to uncontrolled body pain.

*From the Pulmonary Division, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan. Correspondence to: Hideki Katsura, MD, Pulmonary Division, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015 Japan Thomas L. Petty 42nd Annual Aspen Lung Conference; Mechanisms of COPD