Affiliations: Tokyo University Hospital
Postgraduate Institute of Medical Education and Research
Correspondence to: Shinji Teramoto, MD, FCCP, Department of Geriatric Medicine, Tokyo University Hospital, 7–3-1 Hongo Bunkyo-ku, Tokyo, Japan 113-8655; e-mail: shinjit-tky@umin. ac.jp
To the Editor:
We read with great interest the article by Aggarwal and
coworkers (February 1999)1 concerning the interpretation
of spirometric data in relation to anthropometric indexes. The authors
have demonstrated that height estimated from arm span can be
substituted for actual height in patients in whom height cannot be
measured reliably.1 This is very important not only for
patients with lung disease and spinal deformity, but also for older
adults with osteoporosis.1
Although respiratory function is considerably affected by
age,2–3 height and anthropometric indexes also are
affected by age.3–5 Osteoporosis is particularly common
in elderly people. Osteoporotic vertebral fractures increase in number
and incidence with age, and changes in the shape of the thorax
lead to increased dorsal kyphosis and anteroposterior
diameter.3–5 The reported prevalence of vertebral crush
fractures in the United Kingdom is 2.5% for women > 60 years old and
reaches 7.5% for those 80 years old.6 The kyphosis and
deformation of the thoracic cage secondary to osteoporosis impair
pulmonary function, particularly vital capacity, in aged
woman.4 Thoracic kyphosis as measured by Cobb’s angle is
significantly associated with the FVC in women referred for
osteoporosis evaluation.4,7 Because height is considerably
affected by the vertebral fractures, Leech et al4 have
suggested that arm span should be used for predicting lung function
instead of height. Further, we also found that thoracic kyphosis as
measured by Cobb’s angle was significantly associated with maximal
inspiratory pressure (Pimax) and the ratio of residual
volume to total lung capacity in elderly people. Because
Pimax is influenced by the curvature of the diaphragm, the
kyphosis-related alteration of diaphragmatic shape may reduce the
pressure on inspiratory muscles.
Because an understanding of the normal progression of changes in
respiratory function is important in assessing the loss in pulmonary
reserve for elderly people with lung disease,7 height
estimated from arm span may be important for the assessment of lung
function in osteoporotic patients with or without lung disease.
We appreciate the interest shown by Teramoto and colleagues in
our article (February 1999),1 and we fully agree with
their observations on osteoporosis-induced height changes in the
elderly. In fact, we had concluded that arm span is a reasonable
surrogate for standing height in patients in whom height cannot be
reliably measured, provided that a proper relationship between height
and arm span is not available for that population.1 It may
be worthwhile to evolve such a relationship for elderly patients. This
would be useful not only for interpreting pulmonary function data, but
also for other clinical assessments requiring the measurement of
height. Height estimated from arm span using either a fixed ratio or a
regression equation is better than the use of arm span alone.
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