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Associated Loss of Fat-free Mass and Bone Mineral Density in Chronic Obstructive Pulmonary Disease

Section of Respiratory Medicine and Communicable Diseases, and Bone Research Unit, University of Wales College of Medicine, Llandough Hospital, Penarth, Vale of Glamorgan; Department of Medical Physics and Clinical Engineering, University Hospital Wales, Heath Park, Cardiff; and Ely Bridge Surgery, Ely, Cardiff, United Kingdom

Correspondence and requests for reprints should be addressed to D. J. Shale, M.D., Section of Respiratory and Communicable Diseases, University of Wales College of Medicine, Academic Centre, Llandough Hospital, Penlan Road, Penarth, Vale of Glamorgan CF64 2XX, UK. E-mail: shaledj{at}cardiff.ac.uk

We hypothesized that in patients with chronic obstructive pulmonary disease, loss of fat-free mass (FFM) and loss of bone mineral density (BMD) were related to (1) each other and may be clinically inapparent, (2) urinary markers of cellular and bone collagen protein breakdown, and (3) severity of lung disease. Eight-one patients and 38 healthy subjects underwent dual-energy X-ray absorptiometry to determine body composition and BMD. Urinary protein breakdown markers, inflammatory mediators, and their soluble receptors were determined. Thirty-three patients had a low fat-free mass index (kg/m²), 17 of whom had a normal body mass index. Thirty-two percent of patients (13% of healthy subjects) had osteoporosis at the hip or lumbar spine. The marker of cellular protein breakdown was elevated in patients and related to lung disease severity and body composition. The marker of bone collagen breakdown was greater in patients with osteoporosis. Inflammatory mediators were elevated in patients. Loss of FFM and loss of BMD were related, occurred commonly, and could be subclinical in patients with chronic obstructive pulmonary disease. Loss of both was greatest with severe lung disease. Increased excretion of cellular and bone collagen protein breakdown products in those with low FFM and BMD indicates a protein catabolic state in these patients.

Key Words: body composition • dual-energy X-ray absorptiometry • osteoporosis

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