ArticleInternational journal of chronic obstructive pulmonary disease2016
Smokers with emphysema and small airway disease on computed tomography have lower bone density.
Article in International journal of chronic obstructive pulmonary disease, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- The Use of Computed Tomography Densitometry for the Assessment of Emphysema in Clinical Trials: A Position Paper from the Fleischner Society.American journal of respiratory and critical care medicine · 2025Pooled it
- What can we learn about bone density in COPD patients from a chest CT? A systematic review.Croatian medical journal · 2024Pooled it
- Lung-related risk factors associate with low bone mineral density in individuals with former tobacco exposure not meeting osteoporosis screening criteria.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Is Type and Grade of Emphysema Important for Bone Mineral Density and Aortic Calcifications?Journal of clinical medicine · 2024Article
- The relationship of fat and muscle measurements with emphysema and bronchial wall thickening in smokers.ERJ open research · 2024Article
- ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2023Article
- Centrilobular Emphysema Is Associated with Pectoralis Muscle Reduction in Current Smokers without Airflow Limitation.Respiration; international review of thoracic diseases · 2023Article
- Correlation of bone density measured on CT chest with the severity of COVID-19 infection: A retrospective study.PloS one · 2023Article
- Osteoporosis in Patients With Respiratory Diseases.Frontiers in physiology · 2022Review
- Cigarette smoke inhalation impairs angiogenesis in early bone healing processes and delays fracture union.Bone & joint research · 2020Article
- Exploring the Association Between Emphysema Phenotypes and Low Bone Mineral Density in Smokers with and without COPD.International journal of chronic obstructive pulmonary disease · 2020Article
- Differences in bone density on chest CT according to smoking status in males without chronic obstructive lung disease.Scientific reports · 2019Article
- Implementation planning for lung cancer screening in China.Precision clinical medicine · 2019Review
- Radiographic Emphysema, Circulating Bone Biomarkers, and Progressive Bone Mineral Density Loss in Smokers.Annals of the American Thoracic Society · 2018Article
- Hospital admissions and mortality in patients with COPD exacerbations and vertebral body compression fractures.International journal of chronic obstructive pulmonary disease · 2017Article
Corrections and comments
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Authors and funding
11 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Osteoporosis is more common in patients with COPD and in smokers. The aim of this study was to assess whether measures of emphysema and airway disease on computed tomography (CT) were associated with lower bone density or vertebral fractures in smokers with and without COPD. For this purpose, we included participants from the NELSON lung cancer screening trial. Bone density was measured as Hounsfield Units in the first lumbar vertebra, and vertebral fractures were assessed semiquantitatively. The 15th percentile method (Perc15) was used to assess emphysema, and the airway lumen perimeter (Pi10) was used for airway wall thickness. Expiratory/inspiratory-ratiomean lung density (E/I-ratioMLD) was used as a measure for air trapping and tracheal index to assess tracheal deformity. Linear regression models and logistic regression models were used to assess associations between CT biomarkers, bone density, and presence of fractures. Exactly 1,093 male participants were eligible for analysis. Lower Perc15 and higher E/I-ratioMLD were significantly associated with lower bone density (b=-1.27, P=0.02 and b=-0.37, P=0.02, respectively). Pi10 and tracheal index were not associated with bone density changes. CT-derived biomarkers were not associated with fracture prevalence. Bone density is lower with increasing extent of emphysema and small airway disease but is not associated with large airway disease and tracheal deformity. This may indicate the necessity to measure bone density early in smokers with emphysema and air trapping to prevent vertebral fractures.
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Registered trials
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