Prescription Patterns in Patients with Chronic Obstructive Pulmonary Disease and Osteoporosis

Figures & data

Figure 1 Flowchart of patient enrolment and final study sample.

Table 1 Characteristics of COPD Patients with Osteoporosis Who Were and Were Not Treated

Baseline Characteristics, n (%)	Treated Group		Untreated Group		p-value
	N=13,407	%	N=16,204	%
Age, mean (SD), years	70.9927	9.441	67.0571	12.057	<0.0001
Age group					<0.0001
40 ≤ age ≤ 54	849	6.33	3010	18.58
55 ≤ age ≤ 64	2134	15.92	3241	20
65 ≤ age ≤ 74	5213	38.88	4836	29.84
75 ≤ age	5211	38.87	5117	31.58
Sex					<0.0001
Male	4271	31.86	9459	58.37
Female	9136	68.14	6745	41.63
Urbanization level					0.0065
Urban	6088	45.41	7629	47.08
Suburban	5586	41.66	6466	39.9
Rural	1733	12.93	2109	13.02
Comorbidity
Lung cancer	261	1.95	754	4.65	<0.0001
Dyslipidemia	3071	22.91	3752	23.15	0.6128
Hypertension	8716	65.01	9962	61.48	<0.0001
Diabetes mellitus	3492	26.05	4475	27.62	0.0024
Obesity	56	0.42	66	0.41	0.8896
Chronic kidney disease	727	5.42	1223	7.55	<0.0001
Chronic liver disease	2010	14.99	2740	16.9	<0.0001
Malignancy	2398	17.89	3694	22.8	<0.0001
Pneumonia	2095	15.63	3068	18.93	<0.0001
Alcohol-related disease	55	0.41	195	1.2	<0.0001
Renal failure	318	2.37	525	3.24	<0.0001
Dementia	743	5.54	1133	6.99	<0.0001
Alzheimer’s disease	98	0.73	112	0.69	0.6848
Depression	1108	8.26	1154	7.12	0.0002
Coronary artery disease	3809	28.41	4157	25.65	<0.0001
Peripheral vascular disease	864	6.44	1032	6.37	0.7914
Ischemic stroke/Transient ischemic attack	2226	16.6	2674	16.5	0.8156
Hemorrhagic stroke	186	1.39	338	2.09	<0.0001
Heart failure	2083	15.54	2398	14.8	0.0778
Left ventricular hypertrophy	180	1.34	200	1.23	0.4098
Atrial fibrillation	1918	14.31	2118	13.07	0.002
Cardiovascular disease ^a	6481	48.34	7388	45.59	<0.0001
Steroid use	4640	34.61	5518	34.05	0.3162
Median follow-up duration (days, median)	28		1496
COPD exacerbations in one year
Moderate exacerbations					0.7985
0	12,009	89.57	14,521	89.61
1	618	4.61	764	4.71
≥2	780	5.82	919	5.67
Severe exacerbations					0.8581
0	11,482	85.64	13,884	85.68
1	1260	9.4	1537	9.49
≥2	665	4.96	783	4.83
Medication for COPD
LABA	407	3.04	434	2.68	0.0654
LABA/ICS	1399	10.43	1500	9.26	0.0007
LAMA	603	4.5	679	4.19	0.1959
LABA/LAMA	46	0.34	76	0.47	0.0564
SABA	2356	17.57	2770	17.09	0.2788
SAMA	1362	10.16	1661	10.25	0.7953
Systemic β2 agonists	6033	45	6890	42.52	<0.0001
ICS	426	3.18	405	2.5	0.0004
Corticosteroid	7160	53.4	8224	50.75	<0.0001
Methyl-xanthines	7601	56.69	8547	52.75	<0.0001
Antibiotics	7426	55.39	9106	56.2	0.1639

Note: ^aCardiovascular disease included coronary artery disease, peripheral vascular disease, ischemic stroke (transient ischemic attack), hemorrhagic stroke, or heart failure.

Abbreviations: LABA, long-acting β2 agonists; ICS, inhaled corticosteroids; LAMA, long acting muscarinic antagonist; SABA, short-acting β2 agonists; SAMA, short-acting muscarinic antagonist.

Table 2 COPD Patients with Osteoporosis Who Received Treatment Within One Year

	Patients Who Received Treatment		Time from Diagnosis to Treatment	Time from Diagnosis to Treatment
	N=13,407	%	(Mean)(Days)	(Median)(Days)
Bisphosphonates
Alendronate	4840	36.1	380.81	28
Risedronate	17	0.13	1157.18	304
Ibandronate	337	2.51	904.10	149
Zoledronate	849	6.33	535.49	51
Monoclonal antibodies
Denosumab	1135	8.47	894.71	179
Hormone-related therapies
Estrogen	825	6.15	621.78	332
Raloxifene	1306	9.74	471.24	29
Parathyroid hormone (1–34)	431	3.21	504.89	38
Calcitonin injection	1802	13.44	291.77	3
Calcitonin nasal spray	2249	16.77	266.97	10

Table 3 Hazard Ratios for the Prescription of Drugs After Osteoporosis

	N	Crude HR	95% CI		p value	Adjusted HR	95% CI		p value
			Lower	Upper			Lower	Upper
Sex
Male	13,730	Reference				Reference
Female	15,881	1.582	1.493	1.676	<0.0001	1.577	1.487	1.672	<0.0001
Age (years)
40 ≤ age ≤ 54	3859	Reference				Reference
55 ≤ age ≤ 64	5375	2.135	1.848	2.465	<0.0001	1.998	1.844	2.165	<0.0001
65 ≤ age ≤ 74	10,049	3.14	2.752	3.582	<0.0001	2.817	2.577	3.079	<0.0001
75 ≤ age	10,328	3.849	3.377	4.387	<0.0001	3.429	3.179	3.699	<0.0001
Comorbidities
Alcohol-related disease	250	0.408	0.313	0.532	<0.0001	0.905	0.693	1.183	0.4667
Cardiovascular disease	13,869	1.156	1.118	1.196	<0.0001	1.031	0.995	1.069	0.0896
Chronic kidney disease	1950	0.771	0.681	0.872	<0.0001	0.793	0.699	0.899	0.0003
Liver disease	4750	0.791	0.73	0.857	<0.0001	0.926	0.854	1.004	0.0616
Diabetes	7967	0.991	0.954	1.03	0.6531	0.953	0.915	0.992	0.019
Dyslipidemia	6823	0.965	0.927	1.004	0.0807	0.953	0.914	0.995	0.0269
Hypertension	18,678	1.174	1.133	1.217	<0.0001	1.007	0.97	1.046	0.7017
Dementia	1876	1.037	1.008	1.067	0.013	0.932	0.833	1.043	0.2227
Depression	2262	1.117	1.05	1.187	0.0004	1.141	1.072	1.214	<0.0001
Alzheimer’s disease	210	1.143	0.937	1.394	0.1887	1.061	0.866	1.3	0.565
Renal failure	843	0.869	0.777	0.971	0.0132	0.918	0.819	1.03	0.1444
Malignancy	6092	0.953	0.938	0.969	<0.0001	0.893	0.83	0.961	0.0024
Medication
Steroid use	10,158	1.076	1.038	1.115	<0.0001	1.126	1.087	1.167	<0.0001
Estrogen use	825	2.76	2.572	2.962	<0.0001	0.714	0.603	0.844	<0.0001
Urbanization status
Urban	13,717	Reference				Reference
Suburban	12,052	1.069	1.031	1.108	0.0003	1.016	0.98	1.054	0.2879
Rural	3842	1.034	0.98	1.09	0.225	0.954	0.904	1.006	0.077

Abbreviations: CI, confidence interval; HR, hazard ratio.