Comparative study of bone mineral density, phenotypes of emphysema in patients with or without established diagnosis of chronic airway disease


  • M Chandra Sekhar Reddy Department of Medicine, Narayana Medical College, Nellore, Andhra Pradesh
  • G Laxmi Sushmita Department of Pulmonology, Narayana Medical College, Nellore, Andhra Pradesh



Bone mineral density, COPD, emphysema, osteoporosis, smoker


Background: Bone thinning and emphysema are established diseases caused by tobacco-related products proven beyond doubt. A paucity of literature available to establish the association between them. Objectives: To explore the association between the different emphysema subtypes and the presence of low bone mineral density among a population of active or former smokers with and without an established diagnosis of chronic obstructive pulmonary disease (COPD). Methods: 100 active and former smokers with chronic airway disease attending the Pulmonology Outpatient Department were identified, and they were administered clinical questionnaires, pulmonary function tests, chest computed tomography, and DEXA scans. Appropriate statistical tests were performed to analyze the association between the different emphysema subtypes, low bone mineral density, and smoking in the study participants. Results: Out of 100 samples, 80 % of the patients had low BMD (25 had osteoporosis, and 55 had osteopenia). Emphysema was more frequent and severe in patients with osteoporosis (63.2 vs. 36.8%, p=<0.01). For analyzing significant co-factors, a multivariable analysis was done, which yielded Body Mass Index (Odds ratio of 0.89 with a 95% Confidence Interval of 0.67–1.23) and the presence of centrilobular emphysema as most commonly associated with osteoporosis. (Odds ratio of 35.25, with a 95% confidence interval of 3.23 to 401.63). Conclusion: Patients having increased Body Mass Index (BMI) and the presence of centrilobular emphysema are having osteoporosis irrespective of their smoking status, which implicates BMI, and centrilobular emphysema has to be considered while evaluating COPD patients.


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Nathan SD, Waxman A, Rajagopal S, Case A, Johri S, DuBrock H, De La Zerda DJ et al. Inhaled treprostinil and forced vital capacity in patients with interstitial lung disease and associated pulmonary hypertension: a post-hoc analysis of the INCREASE study. Lancet Respir Med 9, 1266-74 (2021)

Wijsenbeek M, Cottin V. Spectrum of Fibrotic Lung Diseases. N Engl J Med 383, 958-68 (2020)

Katzen J, Beers MF. Contributions of alveolar epithelial cell quality control to pulmonary fibrosis. J Clin Invest 130, 5088-99 (2020)

Wong AW, Liang J, Cottin V, Ryerson CJ. Diagnostic Features in Combined Pulmonary Fibrosis and Emphysema: A Systematic Review. Ann Am Thorac Soc 17, 1333-6 (2020)

Karimi-Shah BA, Chowdhury BA. Forced vital capacity in idiopathic pulmonary fibrosis--FDA review of pirfenidone and nintedanib. N Engl J Med 372, 1189-91 (2015)

Kaner RJ, Bajwa EK, El-Amine M, Gorina E, Gupta R, Lazarus HM et al. Design of Idiopathic Pulmonary Fibrosis Clinical Trials in the Era of Approved Therapies. Am J Respir Crit Care Med 200, 133-9 (2019)

Maher TM, Corte TJ, Fischer A, Kreuter M, Lederer DJ, Molina-Molina M et al. Pirfenidone in patients with unclassifiable progressive fibrosing interstitial lung disease: a double-blind, randomised, placebo-controlled, phase 2 trial. Lancet Respir Med 8, 147-57 (2020)

Wells AU, Flaherty KR, Brown KK, Inoue Y, Devaraj A, Richeldi L et al. Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial. Lancet Respir Med 8, 453-60 (2020)

Behr J, Prasse A, Kreuter M, Johow J, Rabe KF, Bonella F et al. Pirfenidone in patients with progressive fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (RELIEF): a double-blind, randomised, placebo-controlled, phase 2b trial. Lancet Respir Med 9, 476-86 (2021)

Pompe E, Bartstra J, Verhaar HJ, de Koning HJ, van der Aalst CM et al. Bone density loss on computed tomography at 3-year follow-up in current compared to former male smokers. Eur J Radiol 89, 177-81 (2017)

Bon J, Fuhrman CR, Weissfeld JL, Duncan SR, Branch RA, Chang CC et al. Radiographic emphysema predicts low bone mineral density in a tobacco-exposed cohort. Am J Respir Crit Care Med 183, 885-90 (2011)

Nambu A, Zach J, Schroeder J, Jin G, Kim SS, Kim YI et al. Quantitative computed tomography measurements to evaluate airway disease in chronic obstructive pulmonary disease: Relationship to physiological measurements, clinical index and visual assessment of airway disease. Eur J Radiol 85, 2144-51 (2016)

Hersh CP, Washko GR, Estépar RS, Lutz S, Friedman PJ, Han MK et al. Paired inspiratory-expiratory chest CT scans to assess for small airways disease in COPD. Respir Res 14, 42 (2013)

Smith BM, Austin JH, Newell JD, D'Souza BM, Rozenshtein A, Hoffman EA et al. Pulmonary emphysema subtypes on computed tomography: the MESA COPD study. Am J Med 127, 94.e7-23 (2014)

Su ZQ, Guan WJ, Li SY, Feng JX, Zhou ZQ, Chen Y et al. Evaluation of the Normal Airway Morphology Using Optical Coherence Tomography. Chest 156, 915-25 (2019)

Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Eur Respir J 49, 1700214 (2017)

MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology 284, 228-43 (2017)

Lynch DA, Austin JH, Hogg JC, Grenier PA, Kauczor HU, Bankier AA et al. CT-Definable Subtypes of Chronic Obstructive Pulmonary Disease: A Statement of the Fleischner Society. Radiology 277, 192-205 (2015)

Barnes PJ. Endo-phenotyping of COPD patients. Expert Rev Respir Med 15, 27-37 (2021)

Barrera G, Bunout D, Gattás V, de la Maza MP, Leiva L, Hirsch S. A high body mass index protects against femoral neck osteoporosis in healthy elderly subjects. Nutrition 20, 769-71 (2004)

Kaenmuang P, Keeratichananont W, Geater SL, Chantamanee N, Srikaew P. Prevalence, predictors, dynamic bone change, and treatment efficacy of osteoporosis among chronic obstructive pulmonary disease patients: a prospective cohort study. Front Med (Lausanne) 10, 1214277 (2023)

de Sire A, Lippi L, Aprile V, Calafiore D, Folli A, D'Abrosca F et al. Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review. J Pers Med 12, 1626 (2022)

Lippi L, Folli A, Curci C, D'Abrosca F, Moalli S et al. Osteosarcopenia in Patients with Chronic Obstructive Pulmonary Diseases: Which Pathophysiologic Implications for Rehabilitation. Int J Environ Res Public Health 19, 14314 (2022)

Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 Update. Endocr Pract 26, 1-46 (2020)

Reid IR. Revisiting osteoporosis guidelines. Lancet Diabetes Endocrinol 9, 805-6 (2021)



How to Cite

Reddy, M. C. S., & Sushmita, G. L. . (2024). Comparative study of bone mineral density, phenotypes of emphysema in patients with or without established diagnosis of chronic airway disease. Journal of Applied Pharmaceutical Research, 12(1), 65-70.




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