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Published ahead of print on September 16, 2004, doi:10.1164/rccm.200406-754OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 12, December 2004, 1286-1293

A more recent version of this article appeared on December 15, 2004
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Submitted on June 15, 2004
Accepted on September 9, 2004

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

Charlotte E Bolton1, Alina A Ionescu1, Kathleen M Shiels1, Rebecca J Pettit2, Peter H Edwards3, Michael D Stone4, Lisette S Nixon1, William D Evans2, Timothy L Griffiths1, and Dennis J Shale1*

1 Section of Respiratory Medicine and Communicable Diseases, University of Wales College of Medicine, Llandough Hospital, Penarth, Vale of Glamorgan, United Kingdom, 2 Department of Medical Physics and Clinical Engineering, University Hospital Wales, Cardiff, Glamorgan, United Kingdom, 3 Ely Bridge Surgery, Cardiff, Glamorgan, United Kingdom, 4 Bone Research Unit, University of Wales College of Medicine, Llandough Hospital, Penarth, Vale of Glamorgan, United Kingdom

* To whom correspondence should be addressed. E-mail: shaledj{at}cf.ac.uk.

We hypothesised that in patients with chronic obstructive pulmonary disease (COPD), loss of fat free mass (FFM) and bone mineral density (BMD) were related to a) each other and may be clinically inapparent, b) urinary markers of cellular and bone collagen protein breakdown and c) severity of lung disease. 81 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. 33 patients had a low fat free mass index (kg/m2), 17 of whom had a normal body mass index. 32% patients (13% 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 BMD were related, occurred commonly and can be subclinical in COPD patients. Loss of both was greatest with severe lung disease. Increased excretion of cellular and bone collagen protein breakdown products in those with a low FFM and BMD indicates a protein catabolic state in these patients.
Key words: body composition, osteoporosis, dual energy x-ray absorptiometry




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