Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures
- N. E. MordenAffiliated withThe Department of Community and Family Medicine, Dartmouth Medical SchoolThe Dartmouth Institute for Health Policy and Clinical PracticeVA White River Junction Rural Health Research Center—Eastern Region Email author
- , S. D. SullivanAffiliated withDepartment of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington
- , B. BartleAffiliated withHines VA Medical Center
- , T. A. LeeAffiliated withHines VA Hospital, Center for Management of Complex Chronic, Institute for Health Research and Policy, University of Illinois at Chicago
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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.
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.
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.
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.
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.
KeywordOsteoporosis Prevention Pulmonary disease
- Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures
Volume 22, Issue 6 , pp 1855-1862
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- 1. The Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA
- 2. The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Suite 300, Lebanon, NH, 03766, USA
- 3. VA White River Junction Rural Health Research Center—Eastern Region, White River Junction VT, Lebanon, NH, USA
- 4. Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA
- 5. Hines VA Medical Center, 2100 S 5TH Ave Ste 111L, Hines, IL, 60141, USA
- 6. Hines VA Hospital, Center for Management of Complex Chronic, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA