Original Article

Prevalence and Significance of Decreased Bone Density in Pulmonary Arterial Hypertension

Authors: Numaan Malik, MD, Kevin McCarthy, RPSGT, Omar A. Minai, MD

Abstract

Objective: Decreased bone mineral density has been found in the advanced stages of various lung diseases. Limited data are available about prevalence and risk factors for osteoporosis/osteopenia (OP) in pulmonary arterial hypertension (PAH).


Methods: Patients with PAH (either idiopathic or secondary to scleroderma [SSC-PAH]) who underwent bone density testing for lung transplant evaluation were included. Results of bone density testing, demographic data, pulmonary function testing, hemodynamic measures, and 6-minute walk distance test (6MWD) were collected.


Results: Thirty-two patients were identified (27 women/5 men, 24 idiopathic PAH/8 SSC-PAH) and OP was found in 22 (69%) patients. Patients with SSC-PAH had more significant indications of OP at all of the measured sites. The OP group had lower FEV1 (P = 0.01) and a significantly lower 6MWD (P = 0.04) as compared with patients with PAH with normal bone density. Hemodynamics indicated no statistically significant differences between the groups other than a lower mean pulmonary artery pressure (P = 0.01) in the OP group. Patients with a history of corticosteroid use and smoking, postmenopausal status, decreased functional capacity (as measured by poor New York Heart Association functional class and 6MWD), SSC-PAH, and need for oxygen during a 6MWD test had an increased risk of OP by univariate logistic regression.


Conclusions: Reduced bone density can be seen in a majority of patients with advanced PAH. Risk factors for reduced bone density include SSC-PAH, reduced 6MWD, need for oxygen during 6MWD testing, reduced FEV1, a history of smoking or corticosteroid use, and postmenopausal status.

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