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Osteoporosis in Diffuse Parenchymal Lung Disease^*

^* From the Departments of Medicine (Drs. Caplan-Shaw, Arcasoy, Shane, Kawut, Lederer, and Wilt, and Ms. Addesso) and Surgery (Dr. Sonett), College of Physicians and Surgeons, and the Department of Medicine (Mr. O’Shea), Mount Sinai School of Medicine, New York, NY.

Correspondence to: Steven Kawut, MD, MS, FCCP, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 622 W 168th St, PH 8E, Room 101, New York, NY 10032; e-mail: sk2097{at}columbia.edu

Abstract

Study objectives: There are no studies focused on skeletal status in patients with diffuse parenchymal lung disease (DPLD). We hypothesized that patients with DPLD referred for lung transplantation would have a high prevalence of osteoporosis related to corticosteroid use or reduced pulmonary function and exercise capacity.

Design: Retrospective cohort study.

Setting: Tertiary care center.

Patients: Eighty-six patients with DPLD referred to our center for lung transplantation evaluation between March 1999 and April 2004.

Measurements and results: Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD) at the lumbar spine, femoral neck, total hip, and radius at the time of referral. Criteria developed by the World Health Organization were used to define osteopenia and osteoporosis. Fifty-five patients (64%) had usual interstitial pneumonia-pattern lung disease, 14 patients (16%) had nonspecific interstitial pneumonia-pattern lung disease, and 17 patients (20%) had other forms of DPLD. Sixty-four patients (74%) were receiving corticosteroids, and 43 patients (50%) were receiving preventive therapy for osteoporosis. Eleven patients (13%; 95% confidence interval [CI], 7 to 22%) met criteria for osteoporosis at any site, and 49 patients (57%; 95% CI, 46 to 68%) had osteopenia. Lower body mass index (BMI) [adjusted odds ratio (OR), 1.3; 95% CI, 1.1 to 1.6; p = 0.007] and Hispanic ethnicity (adjusted OR, 9.7; 95% CI, 1.8 to 52; p = 0.008) were independently associated with an increased risk of osteoporosis. Linear regression analysis confirmed that BMD at the femoral neck and hip was directly associated with BMI (p < 0.002). These findings were not affected by adjustment for the use of corticosteroids or osteoporosis prophylaxis, pulmonary function, or exercise performance.

Conclusions: Reduced BMD was common in patients with DPLD who were referred for lung transplantation. Lower BMD was associated with lower BMI, whereas there was no association with other clinical factors in our cohort. Hispanic patients with DPLD had a higher risk of osteoporosis than non-Hispanic patients, independent of other variables. Given their increased risk of bone loss, patients with DPLD should undergo screening for osteoporosis and receive prophylaxis and treatment according to published guidelines.

Key Words: idiopathic pulmonary fibrosis • interstitial lung diseases • lung transplantation • osteoporosis

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Correction for Volume 129, p. 140
Chest 2006 129: 831. [Full Text] [PDF]

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