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Factors associated with osteoporosis in patients with chronic obstructive pulmonary disease—a nationwide retrospective study

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Abstract

Summary

The present study aimed to identify the factors associated with osteoporosis in patients with chronic obstructive pulmonary disease in Taiwan. The study found that female sex, old age, and use of a high dose of oral corticosteroids were significantly associated with osteoporosis in these patients.

Introduction

Chronic obstructive pulmonary disease (COPD) is becoming an increasingly serious and prevalent issue worldwide. The treatment of COPD with long-term steroid use may cause osteoporosis and have significant influences on disability and mortality. However, few studies have evaluated the association between steroid use and osteoporosis in patients with COPD. The present study aimed to identify the factors, including demographic characteristics and steroid use (oral corticosteroids [OCSs], inhaled corticosteroids, and injected steroids), associated with osteoporosis in patients with COPD in Taiwan.

Methods

This was a retrospective case-control study. Data were obtained from the National Health Insurance Research Database from 1997 to 2009. Cox proportional hazard regression models were used to identify the factors associated with osteoporosis.

Results

The incidence of osteoporosis in the patients with COPD was 1343.0 per 100,000 person-years, the majority of patients were women (63.6 %), and the mean age of the patients was 72.5 years. In multivariate regression analysis, female sex, old age, and use of a high OCS dose with a defined daily dose (DDD) >56 (hazard ratio 1.85, 95 % confidence interval 1.52–2.26, P < .0001) exhibited significant independent associations with osteoporosis.

Conclusions

Female sex, old age, and use of a high OCS dose with a cumulative DDD >56 are associated with osteoporosis in patients with COPD. Additionally, female patients >50 years old and male patients >70 years old have a higher risk of osteoporosis. Medical personnel should actively provide health education for the prevention of osteoporosis in these patients.

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Acknowledgments

This study was supported by a grant from the Chang Gung Medical Foundation. The authors would like to thank the Center of Excellence for Chang Gung Research Datalink for comments and assistance in data analysis. This study used data from the National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare, which was managed by the National Health Research Institutes, Taiwan. The statistical results and conclusions presented in this paper do not represent those of the National Health Insurance Administration, Ministry of Health and Welfare, or the National Health Research Institutes.

Author information

Authors and Affiliations

  1. Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan (Republic of China)

    P.-C. Lu

  2. Department of Traditional Chinese Medicine and Center of Excellence for Chang Gung Research Datalink, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan (Republic of China)

    Y.-H. Yang

  3. Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, 1, Sec. 4, Roosevelt Rd., Zhongzheng Dist., Taipei City, 10617, Taiwan (Republic of China)

    Y.-H. Yang

  4. School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan (Republic of China)

    Y.-H. Yang

  5. Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, 2, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan (Republic of China)

    S.-E. Guo

  6. Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, 2, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan (Republic of China)

    S.-E. Guo

  7. Division of Pulmonary and Critical Care Medicine, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61636, Taiwan (Republic of China)

    S.-E. Guo & T.-M. Yang

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  1. P.-C. Lu
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Corresponding author

Correspondence to S.-E. Guo.

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Conflicts of interest

Financial support was received from the Chang Gung Medical Foundation (CMRPG6D0161, CORPF6D0021, and CMRPF6B0071) and National Science Council (NSC101-2410-H-255-002). This funding body played no role in study design, data analysis, or data interpretation. Pei-Chien Lu, Yao-Hsu Yang, Su-Er Guo, and Tsung-Ming Yang declare that they have no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Ethical approval

This study was approved by the ethics review boards of Chang-Gung Memorial Hospital and the National Health Research Institutes, Taiwan.

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Lu, PC., Yang, YH., Guo, SE. et al. Factors associated with osteoporosis in patients with chronic obstructive pulmonary disease—a nationwide retrospective study. Osteoporos Int 28, 359–367 (2017). https://doi.org/10.1007/s00198-016-3732-2

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  • DOI: https://doi.org/10.1007/s00198-016-3732-2

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