Mild to moderate COPD, vitamin D deficiency, and longitudinal bone loss: The MESA study.
Authors
Affiliations (8)
Affiliations (8)
- Department of Radiology and Radiologic Sciences, Johns Hopkins University, Baltimore, MD, United States.
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, WV, United States.
- Wake Forest University School of Medicine, Winston-Salem, NC, United States.
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States.
- Department of Medicine, Columbia University Medical Center, New York, NY, United States.
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
- Lundquist Institute at Harbor-University of California Los Angeles School of Medicine, Torrance, CA, United States.
- Department of Radiology and Radiologic Sciences, Johns Hopkins University, Baltimore, MD, United States. Electronic address: [email protected].
Abstract
Despite the established association between chronic obstructive pulmonary disease (COPD) severity and risk of osteoporosis, even after accounting for the known shared confounding variables (e.g., age, smoking, history of exacerbations, steroid use), there is paucity of data on bone loss among mild to moderate COPD, which is more prevalent in the general population. We conducted a longitudinal analysis using data from the Multi-Ethnic Study of Atherosclerosis. Participants with chest CT at Exam 5 (2010-2012) and Exam 6 (2016-2018) were included. Mild to moderate COPD was defined as forced expiratory volume in 1 s (FEV<sub>1</sub>) to forced vital capacity ratio of <0.70 and FEV<sub>1</sub> of 50 % or higher. Vitamin D deficiency was defined as serum vitamin D < 20 ng/mL. We utilized a validated deep learning algorithm to perform automated multilevel segmentation of vertebral bodies (T1-T10) from chest CT and derive 3D volumetric thoracic vertebral BMD measurements at Exam 5 and 6. Of the 1226 participants, 173 had known mild to moderate COPD at baseline, while 1053 had no known COPD. After adjusting for age, race/ethnicity, sex, body mass, index, bisphosphonate use, alcohol consumption, smoking, diabetes, physical activity, C-reactive protein and vitamin D deficiency, mild to moderate COPD was associated with faster decline in BMD (estimated difference, β = -0.38 g/cm<sup>3</sup>/year; 95 % CI: -0.74, -0.02). A significant interaction between COPD and vitamin D deficiency (p = 0.001) prompted stratified analyses. Among participants with vitamin D deficiency (47 % of participants), COPD was associated with faster decline in BMD (-0.64 g/cm<sup>3</sup>/year; 95 % CI: -1.17 to -0.12), whereas no significant association was observed among those with normal vitamin D in both crude and adjusted models. Mild to moderate COPD is associated with longitudinal declines in vertebral BMD exclusively in participants with vitamin D deficiency over 6-year follow-up. Vitamin D deficiency may play a crucial role in bone loss among patients with mild to moderate COPD.