Prescription Patterns in Patients with Chronic Obstructive Pulmonary Disease and Osteoporosis

Abstract

Objective Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of osteoporosis. Few studies have addressed the prescription patterns in osteoporosis patients with COPD. The purpose of this study was to conduct a retrospective study of the prescription patterns in patients with COPD and osteoporosis in Taiwan. Methods The study was conducted with data from the Taiwan National Health Insurance Research Database from January 1, 2003, to December 31, 2016. We selected the COPD population in Taiwan older than 40 years with at least one prescription for a bronchodilator. We excluded patients who had osteoporosis, fracture, asthma, or cancer before the diagnosis of COPD. After the diagnosis of COPD, patients who did not have osteoporosis were also excluded. We followed this COPD and osteoporosis cohort until they had been prescribed medication for osteoporosis. Results There were 13,407 patients with COPD and osteoporosis who received osteoporosis treatment. Among the patients who received treatment, the majority were female (n = 9136), accounting for 68.14% of all treated patients. A total of 53.4% of the patients had been prescribed steroids least once within the last year before receiving a diagnosis of osteoporosis. A total of 34.61% of the patients received systemic corticosteroids with a daily dose equivalent to 5 mg of prednisolone within the 3 months prior to the diagnosis of osteoporosis. The older the patient was, the higher the probability of the prescription of medication for osteoporosis. Patients with depression had a high probability of receiving medication for osteoporosis with adjusted hazard ratio of 1.141 (95% confidence interval, 1.072–1.214). Conclusion The rate of prescriptions for the treatment of osteoporosis in patients with COPD was low. Physicians need to be aware of this issue and treat osteoporosis more aggressively in patients with COPD.

Prevalence, risk assessment, and predictors of osteoporosis among chronic obstructive pulmonary disease patients

“…found that osteoporosis was underdiagnosed among COPD patients. [ 9 ] The FEV1% predicted and FEV1/FVC ratios were significantly lower among osteoporotic patients than the nonosteoporotic ones, similar to a recent Taiwanese study. [ 13 ]…”

“…Ethical approval for the study was obtained from the Medical Research and Ethics Committee, Ministry of Health Malaysia, with the following number: KKM/NIHEC/P19-528(11). [ 9 ]…”

Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review

“…Despite the fact that several modifiable risk factors have been identified to have a role in osteoporosis prevention in COPD patients [ 17 ], several barriers still affect the lifestyle approach to osteoporosis in this patient, while a personalized osteoporosis approach is still far from being fully characterized [ 18 , 19 ].…”

Lower Prevalence of Osteoporosis in Patients with COPD Taking Anti-Inflammatory Compounds for the Treatment of Diabetes: Results from COSYCONET

“… 51 Conversely, experimental studies in animals have shown positive effects of metformin on bone loss, 23 , 24 and treatment with oral anti-diabetic medication seems to be associated with increased density bone mineral density, in contrast to insulin, for which lower intestinal absorption and increased urinary excretion of calcium, 16 as well as vitamin D regulation, might play a detrimental role. In cell cultures, osteogenic effects of metformin have been shown, 7 , 8 involving AMPK, mTOR (mechanistic target of rapamycin) complexes 1 and 2 and SIRT6 (sirtuin 6), with effects on NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells), a key pro-inflammatory transcription factor. It also increased OPG (osteoprotegerin) and decreased RANKL (receptor activator of NF-κB ligand) that is associated with osteoclastic activity and bone resorption.…”

“…Osteoporosis is a major comorbidity of chronic obstructive pulmonary disease (COPD). [1][2][3][4][5][6][7] In addition to generic osteoporosis risk factors, such as female sex, higher age, smoking, cachexia and reduced physical capacity, a range of COPD-related risk factors are known to also increase osteoporosis risk, including the severity of pulmonary impairment, vitamin D deficiency, or systemic inflammation, 8,9 with systemic inflammation also an independent predictor of low bone mineral density (BMD) in patients with stable COPD. 10 Diabetes mellitus is also a common comorbidity in COPD, 11 and there is evidence that inflammatory pathways are involved in the pathogenesis of this disease.…”