DOI QR코드

DOI QR Code

Relationship between pulmonary function and bone mineral density in the Korean National Health and Nutrition Examination Survey

  • Lee, In Seon (Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Leem, Ah Young (Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Sang Hoon (Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Rhee, Yumie (Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine) ;
  • Ha, Yoon (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Young Sam (Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2014.10.30
  • Accepted : 2015.01.06
  • Published : 2016.09.01

Abstract

Background/Aims: Osteoporosis is common in chronic obstructive pulmonary disease (COPD) patients. The relationship between osteoporosis and COPD has been primarily reported in patients with moderate to severe COPD, but there is no report in the general population. The aim of this study is to investigate the relationship between bone mineral density (BMD) and lung function in the general Korean population. Methods: This study was based on data acquired from the Fourth and Fifth Korea National Health and Nutrition Examination Surveys (KNHANES IV and V), conducted from 2008 to 2010. The study population included 4,501 subjects (aged${\geq}50$ years) who underwent both spirometry and BMD. The study populations were divided into two groups by sex to correct for the effects of gender on BMD. All female participants were postmenopausal women. Results: The BMD values of the femur neck, total femur, and L-spine tended to decrease with degree of airflow limitation in both genders. To correct confounding factors, data were analyzed and adjusted for age, body mass index, fat free mass index, body fat percentage, smoking amount, parathyroid hormone levels, daily calcium and phosphorus intake, and alkaline phosphatase (ALP) levels. While the BMD of the femur neck, total femur, and L-spine was reduced significantly as age and ALP increased, the correlation between airway obstruction and BMD of all regions disappeared in both genders. Conclusions: In the general population aged 50 years and older, diminution of BMD is not associated with airway obstruction. Further investigation along other factors is needed to determine the possible role of pulmonary function and BMD.

Keywords

Acknowledgement

Grant : BK21플러스

Supported by : 연세대학교

References

  1. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176:532-555. https://doi.org/10.1164/rccm.200703-456SO
  2. Katsura H, Kida K. A comparison of bone mineral density in elderly female patients with COPD and bronchial asthma. Chest 2002;122:1949-1955. https://doi.org/10.1378/chest.122.6.1949
  3. Yawn BP, Kaplan A. Co-morbidities in people with COPD: a result of multiple diseases, or multiple manifestations of smoking and reactive inflammation? Prim Care Respir J 2008;17:199-205. https://doi.org/10.3132/pcrj.2008.00021
  4. Iqbal F, Michaelson J, Thaler L, Rubin J, Roman J, Nanes MS. Declining bone mass in men with chronic pulmonary disease: contribution of glucocorticoid treatment, body mass index, and gonadal function. Chest 1999;116:1616-1624. https://doi.org/10.1378/chest.116.6.1616
  5. Shane E, Silverberg SJ, Donovan D, et al. Osteoporosis in lung transplantation candidates with end-stage pulmonary disease. Am J Med 1996;101:262-269. https://doi.org/10.1016/S0002-9343(96)00155-6
  6. Incalzi RA, Caradonna P, Ranieri P, et al. Correlates of osteoporosis in chronic obstructive pulmonary disease. Respir Med 2000;94:1079-1084. https://doi.org/10.1053/rmed.2000.0916
  7. Graat-Verboom L, Wouters EF, Smeenk FW, van den Borne BE, Lunde R, Spruit MA. Current status of research on osteoporosis in COPD: a systematic review. Eur Respir J 2009;34:209-218. https://doi.org/10.1183/09031936.50130408
  8. Lekamwasam S, Trivedi DP, Khaw KT. An association between respiratory function and bone mineral density in women from the general community: a cross sectional study. Osteoporos Int 2002;13:710-715. https://doi.org/10.1007/s001980200097
  9. Biskobing DM. COPD and osteoporosis. Chest 2002;121:609-620. https://doi.org/10.1378/chest.121.2.609
  10. Bikle DD, Halloran B, Fong L, Steinbach L, Shellito J. Elevated 1,25-dihydroxyvitamin D levels in patients with chronic obstructive pulmonary disease treated with prednisone. J Clin Endocrinol Metab 1993;76:456-461.
  11. Choi JW, Pai SH. Association between respiratory function and osteoporosis in pre- and postmenopausal women. Maturitas 2004;48:253-258. https://doi.org/10.1016/j.maturitas.2003.12.013
  12. Lekamwasam S, Trivedi DP, Khaw KT. An association between respiratory function and hip bone mineral density in older men: a cross-sectional study. Osteoporos Int 2005;16:204-207. https://doi.org/10.1007/s00198-004-1673-7
  13. Sin DD, Man JP, Man SF. The risk of osteoporosis in Caucasian men and women with obstructive airways disease. Am J Med 2003;114:10-14. https://doi.org/10.1016/S0002-9343(02)01297-4
  14. Riancho JA, Gonzalez Macias J, Del Arco C, Amado JA, Freijanes J, Anton MA. Vertebral compression fractures and mineral metabolism in chronic obstructive lung disease. Thorax 1987;42:962-966. https://doi.org/10.1136/thx.42.12.962
  15. Karadag F, Cildag O, Yurekli Y, Gurgey O. Should COPD patients be routinely evaluated for bone mineral density? J Bone Miner Metab 2003;21:242-246.
  16. Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005;82:53-59. https://doi.org/10.1093/ajcn/82.1.53
  17. Bolton CE, Ionescu AA, Shiels KM, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004;170:1286-1293. https://doi.org/10.1164/rccm.200406-754OC
  18. Slinde F, Gronberg A, Engstrom CP, Rossander-Hulthen L, Larsson S. Body composition by bioelectrical impedance predicts mortality in chronic obstructive pulmonary disease patients. Respir Med 2005;99:1004-1009. https://doi.org/10.1016/j.rmed.2004.09.024
  19. Black PN, Scragg R. Relationship between serum 25-hydroxyvitamin D and pulmonary function in the third national health and nutrition examination survey. Chest 2005;128:3792-3798. https://doi.org/10.1378/chest.128.6.3792
  20. Bolotin HH. DXA in vivo BMD methodology: an erroneous and misleading research and clinical gauge of bone mineral status, bone fragility, and bone remodelling. Bone 2007;41:138-154. https://doi.org/10.1016/j.bone.2007.02.022
  21. El Maghraoui A, Roux C. DXA scanning in clinical practice. QJM 2008;101:605-617. https://doi.org/10.1093/qjmed/hcn022
  22. Ferguson GT, Calverley PM, Anderson JA, et al. Prevalence and progression of osteoporosis in patients with COPD: results from the towards a Revolution in COPD health study. Chest 2009;136:1456-1465. https://doi.org/10.1378/chest.08-3016
  23. Smith BJ, Laslett LL, Pile KD, et al. Randomized controlled trial of alendronate in airways disease and low bone mineral density. Chron Respir Dis 2004;1:131-137. https://doi.org/10.1191/1479972304cd025oa

Cited by

  1. Bone Mineral Density in Thyroid Cancer Patients: Data from the Korea National Health and Nutrition Examination Survey vol.17, pp.4, 2016, https://doi.org/10.16956/jes.2017.17.4.153
  2. Association of bone mineral density with lung function in a Chinese general population: the Xinxiang rural cohort study vol.19, pp.1, 2016, https://doi.org/10.1186/s12890-019-1008-2
  3. Sarcopenia in COPD: a systematic review and meta-analysis vol.28, pp.154, 2016, https://doi.org/10.1183/16000617.0049-2019
  4. Adherence to Mediterranean Diet Is Associated With Lung Function in Older Adults: Data From the Health and Retirement Study vol.40, pp.2, 2016, https://doi.org/10.1080/07315724.2020.1740114