What can we learn about bone density in COPD patients from a chest CT? A systematic review

We systematically reviewed the current research literature to 1) investigate whether there was a difference in bone mineral density (BMD) between chronic obstructive pulmonary disease (COPD) patients and non-COPD controls, 2) determine the influence of severity and subtype of COPD on BMD, and 3) determine the risk factors for lower BMD in COPD patients. The Web of Science and PubMed databases were searched on September 25, 2023. Studies where BMD was evaluated with computed tomography (CT) or quantitative CT in patients with COPD were included in the review. We collected data on the number of COPD patients, the average age, average body mass index, average predicted forced expiratory volume in one second (%) or Global Initiative for Chronic Obstructive Lung Disease stage, the average of low attenuation areas, the use of corticosteroid therapy, the use of osteoporosis therapy, the average BMD, and the location of BMD measurement. Twelve studies met our review criteria. Although in several studies COPD was associated with a decreased BMD, most of the studies suggested that COPD, especially in its milder forms, was not strongly associated with osteopenia or osteoporosis of the thoracic and lumbar spine.