COPD's systemic inflammatory effects are postulated to negatively impact bone turnover. After looking at CT scans, PFTs, and steroid history in 190 current and former smokers, Bon et al found visual emphysema on chest CT was highly correlated with osteopenia/osteoporosis, with an odds ratio of 2.55 that was independent of airflow limitation, age, sex, inhaled/oral steroid use, and current smoking status. AJRCCM 2011;183:885-890.