Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma

Abstract

SummaryIn 5,541 community dwelling men, chronic obstructive pulmonary disease, or asthma was associated with lower bone mineral density (BMD) at the spine and total hip and an increased risk of vertebral and nonvertebral fractures independent of age, body mass index, and smoking. Men prescribed with corticosteroids had the lowest BMD.IntroductionIt is unclear whether chronic obstructive pulmonary disease (COPD) is independently associated with BMD and fractures.MethodsIn 5,541 men from the Osteoporotic Fractures in Men Study, history of COPD or asthma, current treatment with corticosteroids, BMD, bone loss after 4.5 years and fractures were ascertained.ResultsSeven hundred fourteen (13%) men reported COPD or asthma, of which 103 were prescribed an oral steroid and 177 an inhaled steroid. Independent of confounders, men prescribed corticosteroids for COPD or asthma had the lowest BMD and a 2-fold increased risk of vertebral osteoporosis compared to men with no history of COPD or asthma (OR 2.13, 95% CI (confidence interval) 1.15–3.93 oral steroids; OR 2.05, 95% CI 1.27–3.31 inhaled steroids). During follow-up, BMD increased at the spine, but there was no difference in bone loss at the hip. However, men with COPD or asthma had a 2.6- and 1.4-fold increased risk of vertebral and nonvertebral fractures, respectively.ConclusionChronic obstructive pulmonary disease or asthma was associated with lower BMD at the spine and hip and increased risk of vertebral and nonvertebral fractures independent of age, clinic site, BMI, and smoking. A history of COPD or asthma may be a useful clinical risk factor to identify patients with osteoporosis.

Osteoporosis and inflammation

“…(31) observed that vertebral fractures were present in up to 50% steroid naive males with COPD. A Osteoporotic Fractures in Men study also demonstrated a 2-fold increased risk of vertebral osteoporosis compared to men with no history of COPD or asthma independent of age, BMI, and smoking (32).…”

Risk factors for fracture in elderly men: a population-based prospective study

“…COPD, asthma and use of inhalation and oral steroids were associated with bone loss in both spine and hip as well as an increased risk of vertebral and non-vertebral fractures in a US male cohort study [28], while others found an increased fracture risk in men with asthma or currently on corticosteroids [12]. In addition, Vestergaard et al [29] found a 1.2-1.3 times higher risk of fractures in patients with a chronic pulmonary disorder.…”

Interpretation and use of FRAX in clinical practice

“…Of the many secondary causes of osteoporosis, those in Table 6 have been consistently documented to be associated with a significant increase in fracture risk. With the exception of chronic obstructive pulmonary disease [56,57], these remain as listed in the Technical Report on FRAX [3]. Of these, their effect on fracture risk can usually be explained by the effect of the disease on decreasing bone density.…”