Letters to Editor

Osteoporosis in Chronic Obstructive Pulmonary Disease Sir, Hattiholi and Gaude studied the ‘prevalence and correlates of osteoporosis in chronic obstructive pulmonary disease (COPD) patients’ and concluded that, ‘as the severity of COPD increased, the risk of osteoporosis increased.’[1] In fact, this observation was seen not only in India, but also in other countries. Watanabe et al. recently reported ‘a high prevalence of osteoporosis in Japanese male COPD patients and a strong inter‑relationship between the two diseases.’[2] Evans and Morgan noted that this was a systematic nature of chronic lung disease.[3] In addition, Sharif et al. reported that the presence of osteoporosis was a risk factor for early re‑admission with COPD.[4] However, an important consideration was the exact pathophysiology. A recent report by Moberg et al., showed no genotype–phenotype relationship.[5] This meant that the observation might be due to the environmental factor. Of interest, in most studies, including in the present study by Hattiholi and Gaude, there was no complete control of the confounding factor. In addition, there was no control group. A high prevalence of osteoporosis in this setting might be seen in cases either with or without COPD.

Sim Sai Tin, Viroj Wiwanitkita1

Shantou, 1Public Health Hainan Medical University, China; University of Nis, Serbia; Joseph Ayobabalola University, Nigeria; Surin Rajabhat University, Thailand; Dr. DY Patil Medical University, India E-mail: [email protected]

REFERENCES 1. 2.

3. 4. 5.

Hattiholi J, Gaude GS. Prevalence and correlates of osteoporosis in chronic obstructive pulmonary disease patients in India. Lung India 2014;31:221‑7. Watanabe R, Tanaka T, Aita K, Hagiya M, Homma T, Yokosuka K, et al. Osteoporosis is highly prevalent in Japanese males with chronic obstructive pulmonary disease and is associated with deteriorated pulmonary function.J Bone Miner Metab 2014. [Epub ahead of print]. Evans RA, Morgan MD. The systemic nature of chronic lung disease. Clin Chest Med 2014;35:283‑93. Sharif R, Parekh TM, Pierson KS, Kuo YF, Sharma G. Predictors of early readmission among patients 40 to 64 years of age hospitalized for chronic obstructive pulmonary disease. Ann Am Thorac Soc 2014;11:685‑94. Moberg M, Ringbaek T, Roberts NB, Vestbo J. Association between Vitamin D status and COPD phenotypes. Lung 2014;192:493‑7.

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Website: www.lungindia.com DOI: 10.4103/0970-2113.152674

Departments of Biomedical Science, Medical Center,

Retrospective cohort versus case–control study - A comment on chronic obstructive pulmonary disease and low bone mass: A case–control study Sir, This is with reference to the article, ‘Chronic obstructive pulmonary disease and low bone mass: A case-control study,’ published in Lung India 2014;31:217‑20.[1] The authors have done a commendable job to assess the prevalence of osteoporosis and osteopenia in chronic obstructive pulmonary disease (COPD) patients attending the King Fahd Hospital of the University (KFHU), Al‑Khobar.[1] However I have a few concerns regarding the methodology of this study. The authors have mentioned in the title of this study that this is a case-control study. However under the 200

heading, ‘Patient and Methods’ it has not been made clear as to how they selected the control group and segregated it from the cases. The authors have included all patients with a diagnosis of COPD attending the Outpatient Clinic, who had a follow up of a minimum of two years during the study period and had details of forced expiratory volume in one second (FEV1), blood bone profile, bone biomarkers, and a Dual‑energy X‑ray absorptiometry (DEXA) scan in their medical records. However, they have failed to select the control group. They should have selected the controls from a similar population as the cases. This is further consolidated by the fact that the authors have Lung India • Vol 32 • Issue 2 • Mar - Apr 2015

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Osteoporosis in chronic obstructive pulmonary disease.

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