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COPD

Updated 19 July 2019

Lung disease patients are at greater risk for osteoporosis and fractures, study shows

A new study reveals that patients with lung diseases, such as COPD, are at a greater risk of fractures and osteoporosis after the age of 40.

Having a chronic lung disease like COPD is tough as it is, mainly because of symptoms like shortness of breath and a persistent cough.

Now experts are warning that the disease may make patients susceptible to osteoporosis as well. Patients who have mild to severe COPD are more likely to suffer from osteoporosis compared to other individuals of the same age and sex.

The study, published in BMJ Open, was conducted by researchers at the University of Nottingham, and the aim was to investigate the incidence of hip fractures and major osteoporotic fractures (MOF).

The study also compared at the presence of osteoporosis in patients suffering from COPD to those who did not. 

The study 

The study gathered the medical records of 80 874 patients with COPD and 308 999 people with different diseases, held by The Health Improvement Network. The Health Improvement Network (THIN) is an anonymous database containing the electronic records of approximately 6.2% of the UK population from 2004 to 2015. All patients were over the age of 40, and diseases other than COPD were not specified. Other areas that were assessed included:

  • Clinical data
  • Medication use
  • Demographics
  • Incidence of osteoporosis
  • Bone fractures
  • History of falls

Fracture risk prediction tools (FRAX and QFracture) were used to estimate the risk of fractures in COPD patients.

Findings 

  • 5.7% of patients with COPD had a higher prevalence of osteoporosis, compared to 3.9% of non-COPD patients.
  • COPD patients had a 1.67 times higher risk of hip fractures and a 1.60 times higher risk of all major osteoporotic fractures than other patients.
  • Both FRAX and QFracture tools delivered a similar discriminatory accuracy for hip fractures alone, which was 76.1% in COPD patients. FRAX was more accurate, with MOF fractures at 71.4%, whereas QFracture only picked up 61.4%

FRAX scores estimated that 40% of COPD patients had a risk equal to or greater than the 3% experiencing a hip fracture, while 8.6% had a risk equal or higher than 20% of any MOF.

QFracture scores yielded similar results with 45.6% at 3% greater risk of hip fractures and 13.2% at 20% or greater risk of MOF.

"An increased risk of fractures and osteoporosis" was attributed to a number of factors which included the use of oral corticosteroids, patients' BMI, physical activity levels and smoking habits.

What experts had to say

According to the investigators, "The Global Initiative for COPD strategy recommends that osteoporosis co-existence should be considered in COPD, and that the UK National Institute for Health and Care Excellence (NICE) guidelines on osteoporosis considers COPD as a secondary cause of osteoporosis, encouraging the use of fracture prediction tools."

They further added, "The identification with a systematic assessment of bone health and addressing prevention and treatment of those at a greater risk of fracture have the potential to improve outcomes for patients with COPD."

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