Objective By measuring the bone mineral density ( BMD ) and bone metabolic markers in elderly male patients with chronic obstructive pulmonary disease ( COPD ), to explore the relationship between COPD and osteoporosis.Methods Totally 203 COPD male patients and 40 healthy controls of the same sex were recruited as the research objects.The bone mineral density ( by Dual - energy X - ray bone mineral density detection instrument ), serum calcium, phosphorus, magnesium, alkaline phosphatase ( T- ALP ), parathyroid stimulated ( PTH ), fasting urinary calcium and creatinine ratio ( Ca/Cr ), tartrate - resistant acid phosphatase ( TRAP ), osteocalcin ( GBP ) and other bone metabolic markers were measured and analyzed.Results ( 1 ) BMD at L1, L3 and L4 , as well as the Neck, GT, and InterTro of the hip of patients with COPD were significantly lower than those in controls ( P ＜ 0.05 ).The BMD values of COPD patients who Inhaled corticosteroids were significantly lower than those of COPD patients who did not inhale corticosteroids only at the L2 and the Neck of the hip ( P ＜ 0.05 ).( 2 ) Serum calcium, phosphorus, and T 鈥?ALP activity levels were not significantly different ( P ＞ 0.05 ), while the serum magnesium, PTH, TRAP, and Ca/Cr ratio were significantly different ( P ＜0.05 ) in COPD patients and controls.Compared with COPD patients who did not inhale corticosteroids, the patients who inhaled corticosteroids had decreased levels of magnesium and BGP, and increased values of TRAP and Ca/Cr ( P ＜0.05 ).( 3 ) The value of BMD at L3 and L4 , as well the Neck and GT of the hip of COPD patients was negatively correlated with duration of corticosteroid therapy ( r = - 0.69, - 0.38, - 0.46, -0.54, respectively, and P＜0.05).Conclusion The level of BMD in Elderly male patients with COPD patients is lower than that in healthy people with the same age.And the BMD change shows no significant difference between COPD patients who inhale corticosteroids and those who do not inhaled.However the Indices of bone absorption increase and the Indices of bone formation decrease in COPD patients who inhaled corticosteroids.%目的 通过测定老年男性慢性阻塞性肺疾病(COPD)患者的骨密度、骨代谢生化指标,探讨COPD与骨质疏松的关系.方法 选择203例老年男性COPD患者(COPD组)和40例同龄同性别健康对照者(对照组)为研究对象,采用双能X线骨密度检测仪进行骨密度测定,同时测定血清钙、磷、镁、血清总碱性磷酸酶(T-ALP)、甲状旁腺激素(PTH)、空腹尿钙与肌酐比值(Ca/Cr)、抗酒石酸盐酸性磷酸酶(TRAP)、骨钙素(GBP)等骨代谢生化指标.结果 (1)COPD组股骨颈部(Neck)、股骨大转子(G.T)、股骨粗隆间(InterTro)、第二腰椎(L2)、第三腰椎(L3)及第四腰椎(L4)的骨密度值低于对照组,差异有统计学意义(P＜0.05);吸入激素的COPD患者骨密度测定值仅在股骨Neck及L2两处低于未吸入糖皮质激素的COPD患者,差异有统计学意义(P＜0.05).(2)COPD组与对照组血清钙、磷及T-ALP、GBP水平间差异无统计学意义(P＞0.05),而血清镁、PTH、TRAP及尿钙/肌酐间差异均有统计学意义(P＜0.05);吸入激素的COPD患者较未吸入者血清镁、BGP降低,TRAP、尿钙/肌酐值升高,差异有统计学意义(P＜0.05).(3)吸入糖皮质激素治疗的时间与左侧股骨Neck、G.T及腰椎L3、L4的骨密度测定值呈负相关(r值分别为-0.69、-0.38、-0.46及-0.54,P＜0.05).结论 老年男性COPD患者的骨密度测定水平低于同龄健康人群.COPD患者中,吸入糖皮质激素者与未吸入者骨密度变化无显著差异,但吸入糖皮质激素者较未吸入者骨吸收指标升高,骨形成指标下降.
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