Skeletal microstructural abnormalities in postmenopausal women with chronic obstructive pulmonary disease

Authors

  • Carolina AM Kulak,

    Corresponding author
    1. Endocrine Division (SEMPR), Department of Internal Medicine, Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
    2. Department of Medicine and Pathology, Columbia University College of Physicians and Surgeons, New York, NY, USA
    3. Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, USA
    • Endocrine Division (SEMPR), Department of Internal Medicine, Clinical Hospital, Federal University of Parana, Av. Agostinho Leao Jr 285, Curitiba, Parana, Brazil 80030-110.
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  • Victoria C Borba,

    1. Endocrine Division (SEMPR), Department of Internal Medicine, Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
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  • Vanda Jorgetti,

    1. Department of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
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  • Luciene M dos Reis,

    1. Department of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
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  • Xiaowei S Liu,

    1. Department of Medicine and Pathology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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  • Donald B Kimmel,

    1. Center for Hard Tissue Research, Department of Medicine, Creighton University, Omaha, NB, USA
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  • Jaime Kulak Jr.,

    1. Department of Obstretrics and Gynecology, Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
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  • Leda M Rabelo,

    1. Pneumology Division, Department of Internal Medicine, Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
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  • Hua Zhou,

    1. Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, USA
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  • X Edward Guo,

    1. Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
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  • John P Bilezikian,

    1. Department of Medicine and Pathology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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  • Cesar L Boguszewski,

    1. Endocrine Division (SEMPR), Department of Internal Medicine, Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
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  • David W Dempster

    1. Department of Pathology, Columbia University College of Physicians and Surgeons, New York, NY, USA
    2. Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, USA
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Abstract

Chronic obstructive pulmonary disease (COPD) is associated with osteoporosis and fragility fractures. The objectives of this study were to assess static and dynamic indices of cancellous and cortical bone structure in postmenopausal women with COPD. Twenty women with COPD who had not received chronic oral glucocorticoids underwent bone biopsies after double tetracycline labeling. Biopsies were analyzed by histomorphometry and µCT and compared with age-matched controls. Distribution of the patients according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was: Type I (15%), Type II (40%), Type III (30%), and Type IV (15%). Mean (±SD) cancellous bone volume (15.20 ± 5.91 versus 21.34 ± 5.53%, p = .01), trabecular number (1.31  ±  0.26 versus 1.77 ± 0.51/mm, p = .003), and trabecular thickness (141 ± 23 versus 174 ± 36 µm, p = .006) were lower in patients than in controls. Connectivity density was lower in COPD (5.56 ± 2.78 versus 7.94 ± 3.08/mm, p = .04), and correlated negatively with smoking (r = −0.67; p = .0005). Trabecular separation (785 ± 183 versus 614 ± 136 µm, p = .01) and cortical porosity (4.11 ± 1.02 versus 2.32 ± 0.94 voids/mm2; p < .0001) were higher in COPD while cortical width (458 ± 214 versus 762 ± 240 µm; p < .0001) was lower. Dynamic parameters showed significantly lower mineral apposition rate in COPD (0.56 ± 0.16 versus 0.66 ± 0.12 µm/day; p = .01). Patients with more severe disease, GOLD III and IV, presented lower bone formation rate than GOLD I and II (0.028 ± 0.009 versus 0.016 + 0.011 µm3/µm2/day; p = 04). This is the first evaluation of bone microstructure and remodeling in COPD. The skeletal abnormalities seen in cancellous and cortical bone provide an explanation for the high prevalence of vertebral fractures in this disease. © 2010 American Society for Bone and Mineral Research

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