• Hirofumi Kiyokawa, Shigeo Muro, Tsuyoshi Oguma, Susumu Sato, Naoya Tanabe, Tamaki Takahashi, Megumi Kudo, Daisuke Kinose, Hiroshi Kondoh, Takeshi Kubo, Yuma Hoshino, Emiko Ogawa, Toyohiro Hirai, and Michiaki Mishima.
• Department of Respiratory Medicine, Kyoto University, Kyoto, Japan.
• COPD. 2012 Jun 1; 9 (3): 235-42.

BackgroundCOPD pathology involves not only the lungs but also extrapulmonary abnormalities. Osteoporosis is one of the most important abnormalities because it may cause vertebral compression fractures and deteriorate pulmonary function. COPD patients have many risk factors for osteoporosis, such as low BMI, decreased activity, systemic inflammation, and use of corticosteroids. Some of these factors have been shown to deteriorate with COPD exacerbations. We previously demonstrated the correlation between emphysema and osteoporosis and between emphysema progression and COPD exacerbations. Thus, the hypothesis that exacerbation causes osteoporosis progression in COPD patients was investigated.MethodsForty-two COPD patients not on osteoporosis treatment for over 2 years were recruited. During follow-up, exacerbations had been prospectively recorded. Thoracic vertebral bone mineral density (BMD) was measured using chest CT, and the annual change in BMD was calculated. The change was compared between patients with and without a history of exacerbations.ResultsThe decrease in thoracic vertebral BMD was greater in patients with than in those without a history of exacerbations (median ΔBMD mg/ml·year: -3.78 versus -0.30, p = 0.02). Moreover, multivariate regression analysis showed that exacerbations and baseline PaO₂ were independent predictors of the BMD decrease (R² = 0.20, p = 0.007, and R² = 0.09, p = 0.03, respectively) after adjustment for baseline age, smoking status, and airflow limitation.ConclusionsThis is the first longitudinal study to demonstrate that COPD exacerbations are independently associated with osteoporosis progression. Osteoporosis progression should be evaluated in COPD patients, especially in those with a history of frequent exacerbations.

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