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A5052 - Are Trunk Pain and Hyperkyphosis Associated with Vertebral Deformity and Arthropathy in Chronic Obstructive Pulmonary Disease (COPD)?
Author Block: Y. Chen1, H. O. Coxson2, T. M. Coupal3, S. Lam4, P. L. Munk3, J. Leipsic5, W. Reid6; 1Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada, 2Centre for Heart Lung Innovation, Vancouver, BC, Canada, 3Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada, 4Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada, 5Department of Radiology and Department of Medicine, Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada, 6Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
RATIONALE Although pain in people with COPD is primarily localized to trunk areas, its etiology is unclear. Similar to the general population, vertebral deformity and arthropathy (degenerative changes in joints between ribs and spine) may contribute to hyperkyphosis and trunk pain in COPD patients. This study aimed to determine whether vertebral deformity and arthropathy and other characteristics (body mass index, lung function, alcohol consumption, and smoking history) were associated with trunk pain and hyperkyphosis in people with and without COPD.
METHODS We collected data from 171 past or current smokers who received a regular chest CT scan to screen for suspicious lung nodules. Participants completed the Brief Pain Inventory (BPI) on the same day as spirometry and chest CT scans. Information on alcohol consumption, smoking history, and demographic characteristics was collected. All the measurements were performed on CT images. Vertebral deformity was assessed using the semi-quantitative method developed by Genant et al and the spinal deformity index (SDI) was obtained. Arthropathy of thoracic vertebral joints was visually inspected by an expert radiologist. Osteoporosis was determined using X-ray attenuation values. Thoracic kyphosis angle was measured using Cobb techniques and hyperkyphosis was defined when the angle was >40°.
RESULTS All the outcome measures of vertebral deformity and arthropathy were similar between COPD (n=91) and non-COPD (n=80) groups except for the prevalence of hyperkyphosis, which was significantly higher in the COPD group (Table 1). Pain was mostly reported in the trunk region (38%), followed by lower extremity (23%). The prevalence of trunk pain was similar between two groups. Thoracic vertebral deformity (OR=3.55) and costotransverse joint arthropathy (OR=1.30) were independent contributors to trunk pain in COPD patients whereas alcohol consumption contributed to trunk pain in the non-COPD group. Similarly, the SDI and the number of narrowed disc spaces were significantly positively related to the BPI intensity, interference, and total scores significantly in COPD patients whereas higher alcohol consumption was positively related to the BPI sub- and total scores in the non-COPD group. Hyperkyphosis in COPD patients was associated with smoking history (OR=1.03) and lung function (OR=0.98), whereas vertebral deformity (OR=1.84) and disc space narrowing (OR=1.71) contributed to hyperkyphosis in the non-COPD group.
CONCLUSIONS This study confirmed that vertebral deformity and arthropathy are associated with trunk pain but not hyperkyphosis in COPD patients, which can provide insight into the etiology of trunk pain and the underlying factors of hyperkyphosis.