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Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity

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Abstract

Summary

A very high rate of osteoporosis, fractures, and low lean mass was observed in patients with chronic obstructive pulmonary disease (COPD). Disease severity was associated with bone and muscle adverse outcomes, while age ≥ 63.5 years old, low lean mass, higher iPTH, and a T-score below − 2.5 were all associated with higher risk of fracture.

Introduction

Osteoporosis is frequently neglected in patients with COPD. We aimed at evaluating the rate of osteoporosis, fractures, and low lean mass in patients with COPD.

Methods

Ninety-nine patients with COPD (53 women, 64.5 ± 9.6 years old, and 46 men, 65.9 ± 8.0 years old) underwent bone densitometry (DXA) with body composition analyses. Healthy individuals (N = 57) not exposed to tobacco matched by sex, age, and body mass index (BMI) were used as controls. Spirometry, routine laboratory workout, and conventional thoracolumbar radiography surveying for vertebral deformities were performed in all patients.

Results

Osteoporosis was found in 40.4% of the COPD patients against only 13.0% of the healthy controls (p = 0.001). Vertebral fractures were seen in 24.4% of the men and 22.0% of the women with COPD. Disease severity (GOLD 3 and 4) was significantly associated with higher risk of vitamin D deficiency (p = 0.032), lower BMD (both men and women at all sites), higher frequency of osteoporosis (in women at all sites), lower skeletal mass index, and higher rate of low lean mass (in both men and women) than healthy controls and COPD patients with milder disease (GOLD 1 and 2). Age was a main predictor of vertebral fractures (OR = 1.164 (1.078–9.297); p < 0.001), while high plasma iPTH (OR = 1.045 (1.005–1.088); p = 0.029) and low ALM (OR = 0.99965 (0.99933–0.99997); p = 0.031) were predictors of non-vertebral fractures.

Conclusion

Highly prevalent in COPD, osteoporosis and low lean mass were associated with FEV1% < 50%. Age, low lean mass, high iPTH, and low bone mass were all significantly associated with fractures in COPD patients.

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Authors and Affiliations

  1. Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil

    R. Q. Graumam, M. M. Pinheiro & C.H.M. Castro

  2. Pulmonology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil

    L. E. Nery

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  1. R. Q. Graumam
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  3. L. E. Nery
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Correspondence to C.H.M. Castro.

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Graumam, R.Q., Pinheiro, M.M., Nery, L.E. et al. Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity. Osteoporos Int 29, 1457–1468 (2018). https://doi.org/10.1007/s00198-018-4483-z

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