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Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures

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Abstract

Summary

To advance our understanding of the burden of fractures among men, we studied a group of men at high risk for low bone strength due to lung disease. We found high rates of fractures but low rates of bone density testing that could predict fracture before it occurs.

Introduction

To advance understanding of the burden of fragility fractures and attention to bone health among men with chronic obstructive lung disease (COPD), we quantified rates of fragility fracture, bone density testing, and anti-resorptive treatment and calculated the number needed to screen (NNS) to prevent one hip fracture in a cohort of men with COPD.

Methods

Veterans Administration (VA) and VA–Medicare administrative data permitted a retrospective cohort study of 87,360 men aged 50 and older, newly diagnosed with COPD between 1999 and 2003. Logistic regression models including patient characteristics, morbidities, and medication use assessed the effect of covariates on fracture and probability of testing or treatment.

Results

Mean age was 66.8. Hip and wrist fracture rates were 3.99 and 1.31 per 1,000 person years, respectively. Mean follow-up was 2.67 years; 4.4% underwent bone densitometry; 2.8% filled anti-resorptive prescriptions. Age, white race/ethnicity, more COPD exacerbations, barbiturate use, and anti-Parkinson’s drug use were significantly associated with fracture. Age, and systemic corticosteroids were most significantly associated with testing or treatment. Based on published adherence and treatment effects, the cohort’s calculated NNS to prevent one hip fracture is 432.

Conclusions

Fracture rate was high and testing and treatment uncommon. The NNS of 432 to prevent one hip fracture is smaller than 731, the NNS for women aged 65–69 for whom universal screening is recommended. Attention to the bone health of this population is warranted. Future research must determine how testing and treatment impact overall quality of life and mortality of men with COPD.

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References

  1. Bass E, French DD, Bradham DD, Rubenstein LZ (2007) Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol 17(7):514–519

    Article  PubMed  Google Scholar 

  2. Braithwaite RS, Col NF, Wong JB (2003) Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 51(3):364–370

    Article  PubMed  Google Scholar 

  3. Haentjens P, Lamraski G, Boonen S (2005) Costs and consequences of hip fracture occurrence in old age: an economic perspective. Disabil Rehabil 27(18–19):1129–1141

    Article  PubMed  CAS  Google Scholar 

  4. Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15(11):897–902

    Article  PubMed  CAS  Google Scholar 

  5. Khasraghi FA, Lee EJ, Christmas C, Wenz JF (2003) The economic impact of medical complications in geriatric patients with hip fracture. Orthopedics 26(1):49–53, discussion 53

    PubMed  Google Scholar 

  6. Biskobing DM (2002) COPD and osteoporosis. Chest 121(2):609–620

    Article  PubMed  Google Scholar 

  7. Iqbal F, Michaelson J, Thaler L, Rubin J, Roman J, Nanes MS (1999) Declining bone mass in men with chronic pulmonary disease: contribution of glucocorticoid treatment, body mass index, and gonadal function. Chest 116(6):1616–1624

    Article  PubMed  CAS  Google Scholar 

  8. Dam TT, Harrison S, Fink HA, Ramsdell J, Barrett-Connor E (2009) Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma. Osteoporos Int 21:1341–1349

    Article  PubMed  Google Scholar 

  9. Vestergaard P, Rejnmark L, Mosekilde L (2007) Fracture risk in patients with chronic lung diseases treated with bronchodilator drugs and inhaled and oral corticosteroids. Chest 132(5):1599–1607

    Article  PubMed  CAS  Google Scholar 

  10. Sin DD, Man JP, Man SF (2003) The risk of osteoporosis in Caucasian men and women with obstructive airways disease. Am J Med 114(1):10–14

    Article  PubMed  Google Scholar 

  11. Lekamwasam S, Trivedi DP, Khaw KT (2005) An association between respiratory function and hip bone mineral density in older men: a cross-sectional study. Osteoporos Int 16(2):204–207

    Article  PubMed  CAS  Google Scholar 

  12. Jorgensen NR, Schwarz P, Holme I, Henriksen BM, Petersen LJ, Backer V (2007) The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study. Respir Med 101(1):177–185

    Article  PubMed  CAS  Google Scholar 

  13. Shane E, Silverberg SJ, Donovan D et al (1996) Osteoporosis in lung transplantation candidates with end-stage pulmonary disease. Am J Med 101(3):262–269

    Article  PubMed  CAS  Google Scholar 

  14. Papaioannou A, Parkinson W, Ferko N et al (2003) Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada. Osteoporos Int 14(11):913–917

    Article  PubMed  CAS  Google Scholar 

  15. Li L, Brennan KJ, Gaughan JP, Ciccolella DE, Kuzma AM, Criner GJ (2008) African Americans and men with severe COPD have a high prevalence of osteoporosis. COPD 5(5):291–297

    Article  PubMed  Google Scholar 

  16. Barr RG, Celli BR, Mannino DM et al (2009) Comorbidities, patient knowledge, and disease management in a national sample of patients with COPD. Am J Med 122(4):348–355

    Article  PubMed  Google Scholar 

  17. Franco CB, Paz-Filho G, Gomes PE et al (2009) Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int 20:1881–1887

    Article  PubMed  CAS  Google Scholar 

  18. Carter JD, Patel S, Sultan FL et al (2008) The recognition and treatment of vertebral fractures in males with chronic obstructive pulmonary disease. Respir Med 102(8):1165–1172

    Article  PubMed  Google Scholar 

  19. Penrod JD, Litke A, Hawkes WG et al (2008) The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 63(8):867–872

    PubMed  Google Scholar 

  20. Vestergaard P, Rejnmark L, Mosekilde L (2007) Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int 18(12):1583–1593

    Article  PubMed  CAS  Google Scholar 

  21. de Luise C, Brimacombe M, Pedersen L, Sorensen HT (2008) Chronic obstructive pulmonary disease and mortality following hip fracture: a population-based cohort study. Eur J Epidemiol 23(2):115–122

    Article  PubMed  Google Scholar 

  22. Leech JA, Dulberg C, Kellie S, Pattee L, Gay J (1990) Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 141(1):68–71

    PubMed  CAS  Google Scholar 

  23. McKnight J, Scott A, Menzies D, Bourbeau J, Blais L, Lemiere C (2005) A cohort study showed that health insurance databases were accurate to distinguish chronic obstructive pulmonary disease from asthma and classify disease severity. J Clin Epidemiol 58(2):206–208

    Article  PubMed  Google Scholar 

  24. Curtis JR, Mudano AS, Solomon DH, Xi J, Melton ME, Saag KG (2009) Identification and validation of vertebral compression fractures using administrative claims data. Med Care 47(1):69–72

    Article  PubMed  Google Scholar 

  25. Curtis JR, Taylor AJ, Matthews RS et al (2009) “Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures? Osteoporos Int 20:1969–1972

    Article  PubMed  CAS  Google Scholar 

  26. Karter AJ, Parker MM, Moffet HH, Ahmed AT, Schmittdiel JA, Selby JV (2009) New prescription medication gaps: a comprehensive measure of adherence to new prescriptions. Health Serv Res 44(5 Pt 1):1640–1661

    Article  PubMed  Google Scholar 

  27. Sawka AM, Papaioannou A, Adachi JD, Gafni A, Hanley DA, Thabane L (2005) Does alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women. BMC Musculoskelet Disord 6:39

    Article  PubMed  Google Scholar 

  28. Nelson HD, Helfand M, Woolf SH, Allan JD (2002) Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137(6):529–541

    PubMed  Google Scholar 

  29. Hansen KE, Swenson ED, Baltz B, Schuna AA, Jones AN, Elliott ME (2008) Adherence to alendronate in male veterans. Osteoporos Int 19(3):349–356

    Article  PubMed  CAS  Google Scholar 

  30. Melton LJ 3rd, Crowson CS, O’Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9(1):29–37

    Article  PubMed  Google Scholar 

  31. Ettinger B, Black D, Dawson-Hughes B, Pressman A, Melton JL (2010) Updated fracture incidence rates for US version of FRAX. Osteoporos Int 21:25–33

    Article  PubMed  CAS  Google Scholar 

  32. Jorgensen NR, Schwarz P (2008) Osteoporosis in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med 14(2):122–127

    Article  PubMed  Google Scholar 

  33. Daniell HW (1972) Osteoporosis and smoking. JAMA 221(5):509

    Article  PubMed  CAS  Google Scholar 

  34. Lewiecki EM, Gordon CM, Baim S et al (2008) International society for clinical densitometry 2007 adult and pediatric official positions. Bone 43(6):1115–1121

    Article  PubMed  Google Scholar 

  35. Lim LS, Hoeksema LJ, Sherin K (2009) Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med 36(4):366–375

    Article  PubMed  Google Scholar 

  36. National Osteoporosis Foundation (2008) The clinician’s guide to prevention and treatment of osteoporosis. http://www.nof.org/professionals/clinicians_guide.htm. Accessed June 17, 2009

  37. Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK (2008) Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med 148(9):680–684

    PubMed  Google Scholar 

  38. Affairs VDCPGUSDoV (2007) Management of Chronic Obstructive Pulmonary Disease (COPD). http://www.healthquality.va.gov/Chronic_Obstructive_Pulmonary_Disease_COPD.asp. Accessed August 27, 2010

  39. Piette JD, Heisler M (2004) Problems due to medication costs among VA and non-VA patients with chronic illnesses. Am J Manage Care 10(11 Pt 2):861–868

    Google Scholar 

  40. Department of Veterans Affairs (2010) Federal benefits for veterans, dependents & survivors. http://www1.va.gov/opa/publications/benefits_book/federal_benefits.pdf. Accessed August 26

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Acknowledgments

Nancy E. Morden received funding from VA ORH Rural Health Resource Center—Eastern Region and Todd A. Lee from A HSR&D IIR 03-307.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. The Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA

    N. E. Morden

  2. The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Suite 300, Lebanon, NH, 03766, USA

    N. E. Morden

  3. VA White River Junction Rural Health Research Center—Eastern Region, White River Junction VT, Lebanon, NH, USA

    N. E. Morden

  4. Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA

    S. D. Sullivan

  5. Hines VA Medical Center, 2100 S 5TH Ave Ste 111L, Hines, IL, 60141, USA

    B. Bartle

  6. Hines VA Hospital, Center for Management of Complex Chronic, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA

    T. A. Lee

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  1. N. E. Morden
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  2. S. D. Sullivan
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  3. B. Bartle
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  4. T. A. Lee
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Corresponding author

Correspondence to N. E. Morden.

Appendix A

Appendix A

Fig. 1
figure 1

Flow chart for creation of a cohort of older, male, active users of the Veterans Administration Health System, newly diagnosed with chronic obstructive lung disease (COPD) in fiscal years 1999–2003

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Morden, N.E., Sullivan, S.D., Bartle, B. et al. Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures. Osteoporos Int 22, 1855–1862 (2011). https://doi.org/10.1007/s00198-010-1423-y

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  • DOI: https://doi.org/10.1007/s00198-010-1423-y

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