Mild to moderate COPD, vitamin D deficiency, and longitudinal bone loss: the Multi-ethnic Study of Atherosclerosis

Despite the established association between chronic obstructive pulmonary disease (COPD) severity and risk of osteoporosis, even after accounting for the known shared confounding variables (e.g., age, smoking, history of exacerbations, steroid use), there is paucity of data on bone loss among mild to moderate COPD, which is more prevalent in the general population.

We conducted a longitudinal analysis using data from the Multi-Ethnic Study of Atherosclerosis. Participants with chest CT at Exam 5 (2010-2012) and Exam 6 (2016-2018) were included. Mild to moderate COPD was defined as forced expiratory volume in 1 s (FEV₁) to forced vital capacity ratio of <0.70 and FEV₁ of 50 % or higher. Vitamin D deficiency was defined as serum vitamin D < 20 ng/mL. We utilized a validated deep learning algorithm to perform automated multilevel segmentation of vertebral bodies (T1-T10) from chest CT and derive 3D volumetric thoracic vertebral BMD measurements at Exam 5 and 6.

Of the 1226 participants, 173 had known mild to moderate COPD at baseline, while 1053 had no known COPD. After adjusting for age, race/ethnicity, sex, body mass index, bisphosphonate use, alcohol consumption, smoking, diabetes, physical activity, C-reactive protein and vitamin D deficiency, mild to moderate COPD was associated with faster decline in BMD (estimated difference, β = -0.38 mg/cm³/year; 95 % CI: -0.74, -0.02). A significant interaction between COPD and vitamin D deficiency (p = 0.001) prompted stratified analyses. Among participants with vitamin D deficiency (47 % of participants), COPD was associated with faster decline in BMD (-0.64 mg/cm³/year; 95 % CI: -1.17 to -0.12), whereas no significant association was observed among those with normal vitamin D in both crude and adjusted models.

Mild to moderate COPD is associated with longitudinal declines in vertebral BMD exclusively in participants with vitamin D deficiency over 6-year follow-up. Vitamin D deficiency may play a crucial role in bone loss among patients with mild to moderate COPD.