P1.11-17 Osteoporosis, Coronary Artery Calcification, and COPD in a Lung Cancer Screening Cohort

Abstract

The US Preventative Services Task Force recommends annual lung cancer screening with low-dose CT scans in adults aged 55-80 who are current smokers (or have quit within the past 15 years) with a >30 pack-years history. The advent of lung cancer screening programs provides an opportunity to assess the resultant CT scans for signs of smoking-related diseases other than lung-cancer. We aimed assess the prevalence of Chronic Obstructive Pulmonary Disease (COPD), coronary artery calcification, and osteoporosis within a lung cancer screening cohort. We recruited subjects from the National Jewish Health Lung Cancer Screening (LCS) Program. In addition to the LCS CT-scan, participants completed a DXA scan, spirometry, a sit-to-stand test, and reported their medical history. Participants were classified by GOLD (Global Initiative for Chronic Obstructive Lung Disease) spirometry grade to correlate lung function, and co-morbid disease. One hundred and thirty-five subjects participated in the study (68 males, 67 females). Mean age was 64.0 (5.8) years, and 32.6% were current smokers. 51% of the cohort had moderate to severe COPD (GOLD 2 or greater). While those who were GOLD 3 or 4 had all been previously diagnosed with COPD, 34% of those classified as GOLD 2 and 85% of GOLD 1 participants had not been previously diagnosed. Undiagnosed coronary artery disease (CAD) was common in the population. Eighty-three percent of those with CAC scores over 1000 did not report a prior diagnosis of CAD. Osteoporosis, or its precursor osteopenia, is present in a large proportion of the LCS cohort. The prevalence of osteoporotic disease increases with increasing COPD severity. Thirty-seven percent of GOLD 3 participants, and 44% of GOLD 4 participants have a Z-score of less than -2.5 (osteoporosis). Osteopenia (Z-score<-1.0) is more common, seen in 100% of GOLD 4 participants, 68% of GOLD 3 participants, 56% of GOLD 2 participants, 27% of GOLD 1, 65% of normal spirometry (GOLD 0), and 32% of PRISm participants. Increasing spirometric disease was associated with reduced physical function as measured by the sit-to-stand test and the SF-36 physical score. Patients enrolled in LCS programs often have disease other than lung cancer that may be detected using a low-dose chest CT scan. Clinicians should consider using these CT scans to screen for osteoporosis and coronary artery disease. Given the prevalence of undiagnosed COPD in LCS patients, further research should investigate a potential benefit of screening these patients for COPD using spirometry.