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

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          Abstract

          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.

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          Most cited references 37

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          Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.

           W MacNee,  ,  B Celli (2004)
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            Pathogenesis of osteoporosis: concepts, conflicts, and prospects.

            Osteoporosis is a disorder in which loss of bone strength leads to fragility fractures. This review examines the fundamental pathogenetic mechanisms underlying this disorder, which include: (a) failure to achieve a skeleton of optimal strength during growth and development; (b) excessive bone resorption resulting in loss of bone mass and disruption of architecture; and (c) failure to replace lost bone due to defects in bone formation. Estrogen deficiency is known to play a critical role in the development of osteoporosis, while calcium and vitamin D deficiencies and secondary hyperparathyroidism also contribute. There are multiple mechanisms underlying the regulation of bone remodeling, and these involve not only the osteoblastic and osteoclastic cell lineages but also other marrow cells, in addition to the interaction of systemic hormones, local cytokines, growth factors, and transcription factors. Polymorphisms of a large number of genes have been associated with differences in bone mass and fragility. It is now possible to diagnose osteoporosis, assess fracture risk, and reduce that risk with antiresorptive or other available therapies. However, new and more effective approaches are likely to emerge from a better understanding of the regulators of bone cell function.
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              Osteoporosis

              The Lancet, 367(9527), 2010-2018
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                27 July 2020
                2020
                : 15
                : 1823-1829
                Affiliations
                [1 ]Pulmonary Department, Hospital Universitari Arnau de Vilanova , Lleida, Spain
                [2 ]Pulmonary Department, Clinica Universidad de Navarra , Pamplona, Spain
                [3 ]Nuclear Medicine Department, Clínica Universidad de Navarra , Pamplona, Spain
                [4 ]Biochemistry Department, Clínica Universitaria de Navarra , Pamplona, Spain
                [5 ]Department of Internal Medicine, Clínica Universidad de Navarra , Pamplona, Spain
                [6 ]Department of Endocrinology & Nutrition, Clínica Universidad de Navarra , Pamplona, Spain
                [7 ]Pulmonary Department, Clínica Universidad de Navarra , Madrid, Spain
                [8 ]Respirology Division, Queen’s University , Kingston, ON, Canada
                Author notes
                Correspondence: Jessica Gonzalez Pulmonary department, Hospital Universitari Arnau de Vilanova , Lleida, Spain Email jgonzalezgutierrez@gmail.com
                Article
                257918
                10.2147/COPD.S257918
                7401322
                © 2020 Gonzalez et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                References: 47, Pages: 7
                Funding
                Funded by: Roche Diagnostics
                This project was funded by a grant from Roche Diagnostics.
                Categories
                Original Research

                Respiratory medicine

                osteoporosis; smokers, emphysema, osteopenia, low bone mineral density, copd

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