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Background: Osteoporosis is prevalent in individuals with COPD. Updated evidence is required to complement the previous systematic review on this topic to provide best practice. The aim of this systematic review and meta-analysis was to quantitatively synthesize data from studies with respect to the prevalence and risk factors for osteoporosis among individuals with COPD.Methods: EMBASE, CINAHL, MEDLINE, and PubMed databases were searched for articles containing the key words "COPD," "osteoporosis," "prevalence," and "risk factor." Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine osteoporosis prevalence and risk factors in individuals with COPD. Meta-regression analyses were conducted to explore the sources of heterogeneity.Results: The pooled global prevalence from 58 studies was 38% (95% CI, 34-43). The presence of COPD increased the likelihood of having osteoporosis (OR, 2.83). Other significant risk factors for osteoporosis in COPD patients were BMI < 18.5 kg/m2 (OR, 4.26) and the presence of sarcopenia (OR, 3.65).Conclusions: Osteoporosis is prevalent in individuals with COPD, and the prevalence seems to be high and similar in many countries. Patients with COPD should be screened for osteoporosis and contributing risk factors. [ABSTRACT FROM AUTHOR]

Background: In smokers, the lung parenchyma is characterized by inflammation and emphysema, processes that can result in local gain and loss of lung tissue. CT measures of lung density might reflect lung tissue changes; however, longitudinal data regarding the effects of CT lung tissue on FEV1 in smokers with and without COPD are scarce.Methods: The 15th percentile of CT lung density was obtained from the scans of 3,390 smokers who completed baseline and 5-year follow-up of the Genetic Epidemiology of COPD (COPDGene) study visits. The longitudinal relationship between total lung capacity-adjusted lung density (TLC-PD15) and FEV1 was assessed by using multivariable mixed models. Separate models were performed in smokers at risk, smokers with preserved ratio and impaired spirometry (PRISm), and smokers with COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging system.Results: The direction of the relationship between lung density and lung function was GOLD stage dependent. In smokers with PRISm, a 1-g/L decrease in TLC-PD15 was associated with an increase of 2.8 mL FEV1 (P = .02). In contrast, among smokers with GOLD III to IV COPD, a 1-g/L decrease in TLC-PD15 was associated with a decrease of 4.1 mL FEV1 (P = .002).Conclusions: A decline in TLC-PD15 was associated with an increase or decrease in FEV1 depending on disease severity. The associations are GOLD stage specific, and their presence might influence the interpretation of future studies that use CT lung density as an intermediate study end point for a decline in lung function.Trial Registry: ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

The article discusses a study which aimed to explore correlations between parameters derived from quantitative computed tomography (QCT) chest scan and diffusing capacity of the lung for carbon monoxide (DLCO) for the assessment of smoking-related lung diseases. Topics covered include the correlation of DLCO in emphysema patients and the relationships between DLCO and other anatomic metrics of lung parenchymal destruction.

Lung cancer is the leading cause of cancer-related mortality in the United States and around the world. There are > 90 million current and ex-smokers in the United States who are at increased risk of lung cancer. The published data from the National Lung Screening Trial (NLST) suggest that yearly screening with low-dose thoracic CT scan in heavy smokers can reduce lung cancer mortality by 20% and all-cause mortality by 7%. However, to implement this program nationwide using the NLST inclusion and exclusion criteria would be extremely expensive, with CT scan costs alone > $2 billion per annum. In this article, we offer a possible low-cost strategy to risk-stratify smokers on the basis of spirometry measurements and emphysema scoring by radiologists on CT scans. [ABSTRACT FROM AUTHOR]

The article discusses a study to determine if those with heterozygous (protease inhibitor [PI] MZ) who have low serum levels of alpha1-antitrypsin are more likely to develop chronic obstructive pulmonary disease (COPD). It states that researchers compared those with PI MZ and PI MM, dividing them into two groups, a control group in Norway composed of 1,669 people, and 2,707 from the rest of Europe and North America. A technical discussion of the study parameters are described, concluding that PI MZ heterozygotes had less FEV1/(F)VC than those with PI MM.

The article presents a study that evaluates the sex differences in emphysema and airway disease in male and female smokers with and without chronic obstructive pulmonary disease (COPD). It states that all subjects completed spirometry, answered epidemiologic respiratory questionnaire, and went through high-resolution computed tomography (CT). It concludes that women had less airway remodeling and that volumetric CT scanning could be an alternative measurement method.

The article presents information on a study which investigates the effect of radiation dose and scanner manufacturer on quantitative computed tomography (CT) scan measurements of lung densitometry in smokers. It says that changes in radiograph dose significantly affected measurements of emphysema and more emphysema was found in the CT scans obtained with a lower radiograph dose.

The article compares the severity of small airway obstruction in both forms of emphysema. The lung histology of nonsmoking control subjects without emphysema was compared to patients with centrilobular emphysema (CLE) and panlobular emphysema (PLE). It was found that mean linear intercept was greater in all three subgroups of emphysema than in control subjects.

This article focuses on a study that is designed to test the hypothesis that quantitative CT that can track the changes that occur in diffuse lung disease. Pulmonary alveolar proteinosis was used as a model of diffuse lung disease because there is significant improvement, and in some instances almost complete resolution, of the infiltrate following an intervention, with the unique opportunity that the dry weight of the material removed from the lung can be measured and compared to the change in CT measured lung weight from before to after lavage.

Study Objective: To determine how the volume and severity of emphysema measured by CT morphometry (CTM) before and after lung volume reduction surgery (LVRS) relates to the functional status of patients after LVRS.Design: A histologically validated CT algorithm was used to quantify the volume and severity of emphysema in 35 patients before and after LVRS: total lung volume (TLV), normal lung volume (< 6.0 mL gas per gram of tissue), volume of mild/moderate emphysema (ME; 6.0 to 10.2 mL gas per gram of tissue), volume of severe emphysema (> 10.2 mL gas per gram of tissue), surface area/volume (SA/V; meters squared per milliliter), and surface area (SA; meters squared). Outcome parameters included maximal cardiopulmonary exercise (CPX) performance in 21 patients and routine pulmonary function in all patients. We hypothesized that baseline CTM parameters predict response to LVRS and that the change in these parameters may offer insight into mechanisms of improvement.Patients and Intervention: Thirty-five patients with severe emphysema who had successful LVRS.Results: The significant decrease in TLV following LVRS was entirely accounted for by a decrease in severe emphysema. The SA/V and the SA both increased significantly following LVRS. The change in maximal CPX in watts following surgery correlated significantly with baseline values of severe emphysema (r = 0.60), which was collinear with TLV, and SA/V. The change in diffusing capacity of the lung for carbon monoxide revealed a significant positive linear relationship with preoperative severe emphysema (r = 0.37) and a negative relationship with ME (r = -0.37). Change in watts revealed a strong relationship with changes in severe emphysema (r = -0.75) and weaker but significant relationships with change in TLV, ME, SA/V, and SA. Other measures of pulmonary function revealed significant albeit less dominant relationships with baseline CTM and change in these indexes.Conclusion: Using CTM, we have identified a close relationship between baseline severe emphysema, or change in severe emphysema, and the improvement in CPX after LVRS. These observations support a potential role of CTM in future clinical trials for predicting responders to LVRS and identifying mechanisms of improvement. [ABSTRACT FROM AUTHOR]