Elevated HDL cholesterol levels are associated with osteoporosis in lung transplant candidates with chronic obstructive pulmonary disease

Summary 

Background

Osteoporosis is common in advanced COPD and worsens rapidly after transplantation, potentially impairing quality of life. Increased high density lipoprotein cholesterol (HDLc) has been observed in COPD and linked with osteoporosis in the general population. This association has not been previously examined in COPD.

Methods

We reviewed the records of 245 COPD patients referred for lung transplant evaluation. Osteoporosis was defined by either dual energy X-ray absorptiometry scan or use of osteoporosis medications. The presence or absence of osteoporosis could be ascertained in 152 subjects. Cholesterol values and other clinical variables were assessed for their association with osteoporosis.

Results

Clinical factors associated with osteoporosis included lower BMI [OR 0.81, 95% CI 0.73–0.90], higher HDLc [OR 1.04, 95% CI 1.02 to 1.07], and worse lung function. HDLc was an independent predictor of OP and demonstrated an inverse linear correlation with T-scores (r = −0.21, p = 0.05), which was stronger amongst males (r = −0.45, p = 0.004).

Conclusion

In COPD patients referred for lung transplantation, osteoporosis is highly prevalent. Raised HDLc levels are common in this group and are independently associated with OP.

Keywords: Chronic obstructive pulmonary disease, High density lipoprotein cholesterol, Lung transplantation, Osteoporosis

Abbreviations: BMD, Bone mineral density, BMI, Body mass index, CAD, Coronary artery disease, COPD, Chronic obstructive pulmonary disease, CVD, Cardiovascular disease, DXA, Dual x-ray absorptiometry, HRT, Hormone replacement therapy, OP, Osteoporosis, WHO, World health organization