Association between osteoporosis and bone metastasis of lung cancer based on opportunistic screening by low-dose computer tomography: a retrospective cohort study

Abstract Background: The interaction between osteoporosis-related bone microenvironment (BMD)and tumor may accelerate bone metastasis. However, the relationship between osteoporosis and lung cancer bone metastasis is unknown. Methods: We performed opportunistic screening for osteoporosis using chest low-dose computerized tomography (LDCT) to assess a relationship between osteoporosis and bone metastases from lung cancer. We used quantitative computed tomography (QCT) software to measure spinal trabecular BMD; we evaluated the density distribution by the American College of Radiology QCT diagnostic criteria for osteoporosis. The diagnosis of bone metastases was based on imaging methods. We obtained optimal cut-off for age by X-tile analysis. Univariate and multivariate COX survival analysis was used to compare the relationship between osteoporosis and bone metastases from lung cancer, and whether age and sex had an effect on the relationship. Results: At baseline, 401 patients with lung cancer, mean age ± standard deviation (SD) 61.7 ± 9.7 years, underwent LDCT opportunistic screening for lung cancer and osteoporosis, including 240 men (mean age ± SD 62.3 ± 9.7 years) and 161 women (mean age ± SD 60.7 ± 9.6 years). During a median follow-up of 21.3 months, 59 patients with lung cancer progressed to bone metastases. Regression analysis showed that the risk of lung cancer bone metastasis for men with osteoporosis was adjusted hazard ratios (HR) 95% confidence interval (CI)(0.27 0.14-0.50), P<0.001. After adjusting for age and sex, regression analysis showed that the lung cancer with osteoporosis for men was adjusted HR 95%CI(0.29 0.14-0.57), P<0.001 ,and greater for patients aged 63 older (adjusted HR 95%CI, 0.32 0.15-0.69 P<0.001). The progression time of bone metastases in patients with lung cancer and osteoporosis was faster, but not statistically different than the progression time of patients without osteoporosis. Conclusion: Overall, our study showed that osteoporosis diagnosed by low-dose chest CT opportunistic screening was associated with bone metastases from lung cancer. The findings proved that osteoporosis was an important risk factor for bone metastases from lung cancer, but osteoporosis cannot accelerate the time to progression of bone metastases. Our study highlights the clinical value of screening for osteoporosis in the prevention and treatment of bone metastases from lung cancer. Trial registration: The study approved by the Ethics Committee of the Henan Provincial 65 People's Hospital.(Ethical Approval Number: 2021 Aaron trial Examination No. (68)).