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COPD as an independent risk factor for osteoporosis and fractures

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Abstract

Summary

Fractures are common in individuals with COPD and occur at higher bone mass values than expected. COPD appears to be an important risk factor for bone fragility.

Introduction

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of osteoporosis and fractures, but screening and prophylactic measures to prevent both disorders are often neglected in this population. This case-control study assessed the prevalence of osteopenia, osteoporosis, and fractures in patients with COPD, and identified potential risk factors for fractures in this population.

Methods

Overall, 91 patients with COPD (COPD group; COPDG) and 81 age- and sex-matched controls (control group; CG) were assessed with bone mineral density (BMD), thoracic/lumbar spine radiographs, and serum PTH and 25-hydroxyvitamin D (25[OH]D) levels. The occurrence of prior fractures was retrieved from clinical history.

Results

The prevalence of total fractures in the COPDG was 57.1% (odds of fracture 4.7 times greater compared with the CG), and the femoral neck T-score emerged as the best predictor of fractures. Compared with the CG, the COPDG had lower spine and femoral BMD (p ≤ 0.01) and 25(OH)D levels (p = 0.01) and 2.6 times greater odds of osteoporosis. Among men, vertebral fractures were more prevalent in the COPDG versus CG (25.9% vs. 6.5%, respectively, p = 0.01). The odds of fracture increased with femoral neck T-scores ≤ − 2.7 in the CG and ≤ − 0.6 in the COPDG.

Conclusion

These results add robust evidence to an increased odds of osteoporosis and fractures in COPD. Fractures in the COPDG occurred at higher BMD values than expected, suggesting that COPD may be an independent marker of fracture risk, reinforcing a need for regular osteoporosis screening with BMD measurement and prophylaxis of fractures in patients with this disorder.

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Acknowledgements

We would like to thank the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) for the financial support of the authors M.G.A.O. and M.R.G. and the laboratory tests, and to Roche Diagnostica Brasil for providing the kits for the measurement of bone metabolic markers. We also thank Milena Braga-Basaria (Voxmed Medical Communications) for critically reviewing and suggesting improvements to the manuscript.

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Authors and Affiliations

  1. Discipline of Endocrinology, Escola Paulista de Medicina (UNIFESP) Universidade Federal de São Pulo, Federal University of São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, Brazil

    M.G. Adas-Okuma, S.S. Maeda, J.G.H. Vieira & M. Lazaretti-Castro

  2. Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil

    M.R. Gazzotti, C.M. Roco, C.O. Pradella, O.A. Nascimento, E.F. Porto & J.R. Jardim

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  1. M.G. Adas-Okuma
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  2. S.S. Maeda
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Correspondence to M.G. Adas-Okuma.

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Adas-Okuma, M., Maeda, S., Gazzotti, M. et al. COPD as an independent risk factor for osteoporosis and fractures. Osteoporos Int 31, 687–697 (2020). https://doi.org/10.1007/s00198-019-05235-9

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