COPD Patients More Likely to Sustain Fracture

According to a recent study published in BMJ Open, patients with chronic obstructive pulmonary disease (COPD) have a greater likelihood of fracture and osteoporosis.

“Osteoporosis in both male and female patients with chronic obstructive pulmonary disease (COPD) is firmly established as one of the core comorbid conditions,” the study authors wrote, adding, “The aim of this study was to assess the incidence of hip fracture alone or all major osteoporotic fractures (MOF) in patients with COPD (n = 80,874) compared with non-COPD patients (n = 308,999), and to evaluate the use and performance of fracture risk prediction tools in patients. Further, to assess the prevalence of coded osteoporosis up to the time of COPD diagnosis and the incidence of osteoporosis.”

The researchers gathered data from The Health Improvement Network, a United Kingdom database representing 6.2% of the total population. Patients aged ≥ 40 years who received an incident COPD diagnosis from 2004 to 2015 were matched to up to four non-COPD patients by age, sex, and general practice. Mean patient age was 66.9 years in the COPD cohort and 66.5 years in the non-COPD cohort.

Osteoporosis and Fracture Incidence

COPD patients had a higher rate of osteoporosis up to the index date compared to the non-COPD group (5.7% versus 3.9%, p < 0.001). During the one-year period before and after the index date, 1,504 (1.86%) COPD patients had a new osteoporosis diagnosis, and 3,059 (1.12%) of non-COPD patients had one (p < 0.001). More than one year prior to the index date, 3,186 (3.94%) of COPD patients had an osteoporosis diagnosis, compared to 8,822 (2.86%) of the non-COPD patients (p < 0.001).

“Demographics remained similar after excluding those with former coded osteoporosis,” wrote the researchers. “Patients with COPD (n=73 084) compared with non-COPD patients (n=2 64 544) were significantly more likely to have an incident diagnosis of osteoporosis.”

Compared to the controls, COPD patients had a significantly increased risk for MOF (hazard ratio [HR] 1.60, 95% CI 1.52–1.69) and hip fracture alone (HR 1.68, 95% CI 1.56–1.80). However, in fully adjusted models, this difference diminished (MOF, HR 1.04, 95% CI 0.96–1.12; hip fracture, HR 1.09, 95% CI 0.98–1.21).

The researchers also assessed the discriminatory accuracies (area under the receiver operating characteristic curve) of two fracture risk prediction tools—FRAX and QFracture—in COPD. Few COPD patients had a FRAX assessment READ-coded ever documented in the records: 1,074 (1.33%); only 12 patients had a READ-coded QFracture assessment. During the one-year time period before and after the index date, 248 (0.31%) of COPD patients had a documented FRAX assessment READ-coded, and one had QFracture.

“When the FRAX and QFracture scores were calculated for patients with COPD, for hip fracture there were 29 035 (40.0%) patients who had a risk≥3% using FRAX and 33 065 (45.6%) patients using QFracture,” the study authors wrote. “For any MOF, 6221 (8.6%) of the patients had a risk≥20% using FRAX and 9546 (13.2%) patients using QFracture.” Hip fracture discriminatory accuracy was similar between FRAX and QFracture, but FRAX had a higher accuracy for MOF.

The authors concluded, “In summary, despite validated fracture risk prediction tools, there was very little assessment of the increased fracture risk in patients with COPD. However, on retrospective calculation of fracture risk, the tools identify those patients with COPD at greatest risk of fracture.”