Osteoporosis International

, Volume 14, Issue 11, pp 913–917 | Cite as

Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada

  • A. Papaioannou
  • W. Parkinson
  • N. Ferko
  • L. Probyn
  • G. Ioannidis
  • E. Jurriaans
  • G. Cox
  • R. J. Cook
  • D. Kumbhare
  • J. D. Adachi
Original Article


Purpose: Patients with chronic obstructive pulmonary disease (COPD) may be at higher risk for osteoporosis. The primary objective of this case-control study was to determine the prevalence of vertebral fractures among patients with COPD admitted to acute care compared with a gender- and age-matched control group. Subjects and methods: Subjects were identified by chart reviews from an acute care hospital in Hamilton, Ontario, in 1999, including patients who were over 50 years old. In total, 127 patients with ICD-9 codes specifying COPD were randomly selected and compared with 127 gender- and age-matched controls. Chest radiographs were interpreted by two radiologists who defined and graded vertebral fractures using Genant’s method. Medications taken, or prescribed at discharge, were recorded from charts. Results: The overall prevalence of at least one vertebral fracture was found to be 34/127 (26.8%) in the COPD patients compared with 30/127 (23.6%) in the controls (p=0.556). A significantly greater proportion of COPD patients had at least one severe vertebral fracture (OR=3.75, 95% CI 1.24 to 11.3). Review of hospital chest X-ray reports indicated that only 12 of 64 (18.8%) patients with vertebral fractures identified by the study radiologists actually had a vertebral fracture noted in the report. The proportion of COPD patients with vertebral fractures who were discharged on osteoporosis therapy was 5/27 (18.5%). There was a suggestion of lower lung function, as measured by forced vital capacity (FVC%), in patients with severe vertebral fractures (p=0.067). Conclusions: These data indicate that: (1) There is an increased proportion of COPD patients with severe vertebral fracture, and (2) Documentation and treatment of osteoporosis in acute care COPD patients is low. Therefore, there is a need to target this high-risk group for osteoporosis screening and potential clinical management.


Chronic obstructive pulmonary disease Corticosteroids Osteoporosis Vertebral fractures 


  1. 1.
    Genant HK, Cooper C, Poor G et al (1999) Interim report and recommendations of the World Health Organization task-force for osteoporosis. Osteoporos Int 259–264Google Scholar
  2. 2.
    Cooper C, Melton LJ (1992) Vertebral fractures, how large is the silent epidemic? BMJ 304:793–794PubMedGoogle Scholar
  3. 3.
    Klotzbeucher CM, Ross PD, Landsman PB et al (2000) Patients with prior fracture have an increased risk of future fracture: summary of literature and statistical synthesis. J Bone Miner Res 15:721–727PubMedGoogle Scholar
  4. 4.
    Gross NJ (2001) Extrapulmonary effects of chronic obstructive pulmonary disease. Curr Opin Pulm Med 7:84–92PubMedGoogle Scholar
  5. 5.
    Manolagas SC, Weinstein RS (1999) New developments in the pathogenesis and treatment of steroid-induced osteoporosis. J Bone Miner Res 14:1061–1066PubMedGoogle Scholar
  6. 6.
    Likert BP, Raiaz LG (1990) Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 112:352–364PubMedGoogle Scholar
  7. 7.
    Ruegsegger P, Medici TC, Anliker M (1983) Corticosteroid-induced bone loss. A longitudinal study of alternate day therapy in patients with bronchial asthma using quantitative computed tomography. Eur J Clin Pharmacol 25:615–620PubMedGoogle Scholar
  8. 8.
    Goldstein MF, Fallon JJ, Harning R (1999) Chronic glucocorticoid therapy-induced osteoporosis in patients with obstructive lung disease. Chest 116:1733–1749CrossRefPubMedGoogle Scholar
  9. 9.
    Jones A, Fay JK, Burr M et al (2002) Review: Inhaled corticosteroids for asthma or chronic osbstructive pulmonary disease do not increase bone loss. Cochrane Database Syst Rev 1Google Scholar
  10. 10.
    Papaioannou A, Adachi JD, Parkinson W, Stephenson G, Bedard M (2001) Lengthy Hospitalization Associated with Vertebral Fractures Despite Control for Comorbid Conditions. Osteoporos Int 12(10):870–874CrossRefPubMedGoogle Scholar
  11. 11.
    Genant HK, Jergas M, Palermo L et al (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. J Bone Miner Res 11:984–996PubMedGoogle Scholar
  12. 12.
    Dubois EF, Roder E, Dekhuijzen R, Zwinderman AE, Schweitzer DH (2002) Dual energy x-ray absorptiometry outcomes in male COPD patients after treatment with different glucocorticoid regimens. Chest 121:1456–1463CrossRefPubMedGoogle Scholar
  13. 13.
    Walsh LJ, Wong CA, Oborne J et al (2001) Adverse effects of oral corticosteroids in relation to dose in patients with lung disease. Thorax 56:279–284CrossRefPubMedGoogle Scholar
  14. 14.
    McEvoy CE, Ensrud KE, Bender E et al (1998) Association between corticosteroid use and vertebral fractures in older men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157:704–709PubMedGoogle Scholar
  15. 15.
    Riancho JA, Gonzalez Macias J, Delarco C et al (1987) Vertebral compression fractures and mineral metabolism in chronic obstructive lung disease. Thorax 42:962–966PubMedGoogle Scholar
  16. 16.
    Jackson SA, Tenenhouse A, Robertson L et al (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int 11:680–687CrossRefPubMedGoogle Scholar
  17. 17.
    Melton LJ III, Kan SH, Frye MA et al (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1011PubMedGoogle Scholar
  18. 18.
    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. 141:68–71Google Scholar
  19. 19.
    Schlaich C, Minne HW, Bruckner T et al (1998) Reduced pulmonary function in patients with spinal osteoporotic fracture. Osteoporos Int 8:261–267PubMedGoogle Scholar
  20. 20.
    Kado DM, Browner WS, Palermo L et al (1999) Vertebral fractures and mortality in older women: a prospective study. Arch Intern Med 159:1215–1220PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2003

Authors and Affiliations

  • A. Papaioannou
    • 1
    • 6
  • W. Parkinson
    • 2
  • N. Ferko
    • 3
  • L. Probyn
    • 4
  • G. Ioannidis
    • 1
  • E. Jurriaans
    • 4
  • G. Cox
    • 1
  • R. J. Cook
    • 5
  • D. Kumbhare
    • 1
  • J. D. Adachi
    • 1
  1. 1.Department of MedicineMcMaster UniversityHamiltonCanada
  2. 2.School Rehabilitation SciencesMcMaster UniversityHamiltonCanada
  3. 3.Department of Clinical Health SciencesMcMaster UniversityHamiltonCanada
  4. 4.Department of RadiologyMcMaster UniversityHamiltonCanada
  5. 5.Department of Statistics and Actuarial SciencesUniversity of WaterlooWaterlooCanada
  6. 6.Hamilton Health SciencesHamiltonCanada

Personalised recommendations