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“Smoking caused me to develop osteoporosis”

Life-Saving and Life-Changing Stories from Chest CT Scans

Bone Density Case Studies

*All patient names are fictitious.

**Some stories have been compiled from several case studies and publications.

A lifelong smoker, Ichiro was scared that he might have lung cancer. He already had COPD that required glucocorticoid medications to help him breathe. Ichiro decided to get a HeartLung.AI scan. He didn’t have cancer; however, he did have osteoporosis. Because the scan detected this “silent disease,” Ichiro could make changes to strengthen his bones.

Ichiro* became worried that he might have lung cancer. An Asian male teacher, age 62, he had been a smoker since he was 16 years old. Ichiro had started to develop signs of chronic obstructive pulmonary disease (COPD) about ten years earlier: shortness of breath, trouble exercising, coughing, and lack of energy. He often experienced frequent lung infections.1 The best treatment for COPD is to quit smoking; Ichiro had tried several times and managed to cut back but couldn’t quite shake his habit of 46 years.

His primary care physician told Ichiro that at that there is no cure for COPD. To help ease Ichiro’s difficult breathing, the physician prescribed an inhaler and a drug that contain powerful anti-inflammatory properties that help open the airways. Two common names for these medications, called glucocorticoids, are prednisone and budesonide.(4)

COPD is an inflammation of the airways in the lungs. Breathing is difficult because air can’t move in and out effectively, causing distress and anxiety. Over 16 million people have this disease; millions more have COPD and aren’t being treated.(2) The most common forms of COPD are emphysema and chronic bronchitis.

When Ichiro saw an online article about a simple and inexpensive test that could tell if he had early lung cancer, he decided to learn more. The test is called a low-dose CT scan that examines the entire chest area: heart, lungs, spine, liver, and some abdominal fat. The test uses Artificial Intelligence (AI) to instantly analyze and compare the results to thousands of other scans, coming up with an accurate report.

Ichiro made an appointment and went to a nearby facility. In less than 30 minutes total, wearing his street clothes, his chest scan was completed. His results were available to him and his physician by the time he got back home.

It was a happy surprise to learn that he did not have any abnormal nodes in his lungs, which might have indicated early lung cancer. It was also a shock to find out he had osteoporosis! Like most men, Ichiro thought that it was “only a woman’s disease.”(5) However, up to 1 in 4 men will break a bone due to osteoporosis; a man is more likely to fracture a bone from osteoporosis than to get prostate cancer.(7) And Asians are at higher risk because of their smaller bone structure.(13)

The chest CT scan found that the small bones that make up Ichiro’s spine, called vertebrae, were thin and weak. With osteoporosis, the vertebrae can fracture and collapse, usually without any discomfort.(6) Osteoporosis is called a “silent disease,”(3) because it develops undetected over many years, with no symptoms or pain until a bone finally fractures.

Although the most common breaks occur in the spine, hip, or wrist,(8,11) advanced osteoporosis can cause a rib to fracture from even a cough or sneeze.11 Over time, the spine becomes shorter, resulting in a “hunchback” appearance, with pain and loss of motion.8

Ichiro returned to his physician to review the results of his chest CT scan. Because of his smoking history and long-term use of glucocorticoids, Ichiro had increased his risk of developing osteoporosis. Also, because of difficulty breathing, he didn’t always feel hungry, so his diet lacked protein, calcium, and vitamin D. And because Ichiro lacked energy, he didn’t feel like doing much physical activity, resulting in even more bone loss.

His doctor said that if Ichiro could quit smoking, they could keep the COPD from progressing. After reading the results of his scan and cheering the good news that he didn’t have lung cancer, Ichiro agreed to do whatever was necessary to stop. He also started to take a front-line medication for osteoporosis, called a bisphosphonate, that helps strengthen bone and prevent fractures(12) in people who also need to take glucocorticoids to manage their COPD.(9,10)

He also met with a dietician to see how he could meet his nutritional needs, including adding important supplements like calcium and vitamin D. Then, he began a walking program to do weight-bearing physical activity. Finally, he returned to his career as a teacher.

Because Ichiro decided to have a low-dose CT scan, he took two steps closer to a healthier lifestyle. First, he committed to stop smoking. Second, he took action to prevent his osteoporosis from progressing.


  1. Johnson J, What is the average age for COPD? October 16, 2018. Medically reviewed by E Luo, MD. Medical News Today. https://www.medicalnewstoday.com/articles/323350#what-is-the-typical-age-of-onset-for-copd (Accesses 2 October 2021)

  2. What is COPD? Centers for Disease Control and Prevention, Atlanta, GA. https://www.cdc.gov/copd/index.html (Accessed 2 October 2021)

  3. Chronic obstructive pulmonary disease (COPD), MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/000091.htm (Accessed 2 October 2021)

  4. Fooks C, BPharm. Glucocorticoids, Drugs.com, https://www.drugs.com/drug-class/glucocorticoids.html (Accessed 2 October 2021)

  5. Osteoporosis in Men, NIH Osteoporosis and Related Bone Diseases National Resource Center, Washington, DC. https://www.bones.nih.gov/health-info/bone/osteoporosis/men (Accessed 2 October 2021)

  6. Xu X, Perera S, Greenspan S. Height Loss, Vertebral Fractures, and the Misclassification of Osteoporosis. Bone. 2011 Feb 1;48(2):307-311. (Accessed on PubMed 6 September 2021)

  7. Just for Men. National Osteoporosis Foundation, Arlington, VA. https://www.nof.org/preventing-fractures/general-facts/just-for-men/ https://www.nof.org/preventing-fractures/general-facts/just-for-men/ (Accessed 2 October 2021)

  8. Osteoporosis Overview, NIH Osteoporosis and Related Bone Diseases National Resource Center, Washington, DC. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview (Accessed 2 October 2021)

  9. Compston, J. Management of glucocorticoid-induced osteoporosis. Nat Rev Rheumatol 6, 82–88 (2010). https://doi.org/10.1038/nrrheum.2009.259 (Accessed 2 October 2021)

  10. Akirov A. Management of Glucocorticoid-Induces Osteoporosis: An Overview. Endocrinology Advisor, March 17,2020. https://www.endocrinologyadvisor.com/home/topics/bone-metabolism/overview-of-treatments-for-steroid-induced-osteoporosis/ (Accessed 2 October 2021)

  11. Osteoporosis and Spinal Fractures. OrthoInfo. American Academy of Orthopaedic Surgeons, Rosemont, IL. https://orthoinfo.aaos.org/en/diseases--conditions/osteoporosis-and-spinal-fractures/ (Accessed 3 September 2021)

  12. Harding, M. Bisphosphonates. Medically reviewed by John Cox, MD, March 12, 2018. Patient Info. https://patient.info/bones-joints-muscles/osteoporosis-leaflet/bisphosphonates (Accessed 2 October 2021)

  13. Elan R. How does the incidence of osteoporosis differ among racial groups? Medscape, January 20, 2021. https://www.medscape.com/answers/330598-82988/how-does-the-incidence-of-osteoporosis-differ-among-racial-groups (Accessed 17 October 2021)

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