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

Figures & data

Table 1 Patient Characteristics Including Demographics, Lung Function, COPD Categories, Major Comorbidities and Medication

Variable	All	No Osteoporosis	Osteoporosis	p value
	N = 2222	N = 1871	N = 351
Demographics
Age (y)	65.0 ± 8.4	64.8 ± 8.6	66.2 ± 7.5	0.005
Sex m/f	1359 (61.2%)/863 (38.8%)	1225 (65.5%)/646 (34.5%)	134 (38.2%)/217 (61.8%)	<0.001
BMI (kg/m^2)	26.6 ± 5.2	26.9 ± 5.2	25.2 ± 4.9	<0.001
Smoking status (active)	552 (24.8%)	481 (25.7%)	71 (20.2%)	0.029
Lung function
FEV1 (% predicted)	52.8 ± 18.4	53.4 ± 18.4	49.5 ± 18.4	<0.001
FVC (% predicted)	78.5 ± 18.9	79.2 ± 19.0	75.1 ± 18.2	<0.001
RV/TLC (%)	54.4 ± 11.0	53.6 ± 10.9	58.4 ± 10.6	<0.001
GOLD grades 1/2/3/4	200/945/852/225	174/821/702/174	26/124/150/51	0.001
GOLD groups A/B/C/D	861/556/290/515	765/467/248/391	96/89/42/124	<0.001
Comorbidities
Asthma	425 (19.1%)	325 (17.4%)	100 (28.5%)	<0.001
Diabetes	288 (13.0%)	253 (13.5%)	35 (10.0%)	0.069
Arterial hypertension	1254 (56.4%)	1042 (55.7%)	212 (60.4%)	0.103
Cardiac disease	461 (20.7%)	383 (20.5%)	78 (22.2%)	0.458
Medication
ICS	1460 (65.7%)	1200 (64.1%)	260 (74.1%)	<0.001
OCS	280 (12.6%)	200 (10.7%)	80 (22.8%)	<0.001
Cardiac medication	1327 (59.7%)	1087 (58.1%)	240 (68.4%)	<0.001
Oral anti-diabetes medication	222 (10.0%)	199 (10.6%)	23 (6.6%)	0.019
All anti-inflammatory diabetes medication	175 (7.9%)	162 (8.7%)	13 (3.7%)	0.002
Any metformin-containing medication	140 (6.3%)	131 (7.0%)	9 (2.6%)	0.002

Note: Data are mean ± standard deviation or number (percent).

Abbreviations: FEV₁, forced expiratory volume in 1 s; FVC, forced vital capacity; RV/TLC, ratio of residual volume to total lung capacity determined by body plethysmography; BMI, body mass index; ICS, inhaled corticosteroids; OCS, oral corticosteroids.

Table 2 Results of Logistic Regression Analyses During Several Steps, Leading to Final Step 8

Predictor	Step 1	Step 2	Step 3	Step 4	Step 5	Step 6	Step 7	Step 8
Demographics
Age (per 10 y)	1.307***		1.252**	1.247**	1.215*	1.215*	1.179*	1.182*
Sex (female vs male)	3.087***		2.797***	3.178***	2.771***	2.848***	2.827***	2.829***
BMI (kg/m^2)	0.942***		0.951***	0.931***	0.946***	0.945***	0.941***	0.942 ***
Smoking status (active)	0.699*		0.729*	0.733*	0.756^a	0.810	0.841	0.850
Lung function
FEV1 (% predicted)		1.007
FVC (% predicted)		1.009
RV/TLC (%)		1.063***	1.028***		1.029***	1.023***	1.022***	1.022***
Comorbidities
Asthma				1.650***	1.746***	1.576**	1.620***	1.643***
Sleep apnea				1.157
Diabetes				0.870^a	0.857	0.837	0.828	1.371
Arterial hypertension				1.342*	1.319*	1.278	0.902	0.912
Cardiac disease				1.363^a	1.359*	1.383*	1.257^a	1.259
Hyperuricemia				1.202
Hyperlipidemia				1.073
Medication
ICS						1.222^a	1.198	1.199
OCS						1.956***	1.863***	1.818***
Cardiac medication							1.742**	1.723**
Diabetes medication^b								0.358**

Notes: Odds ratios (Exp [B]) values are shown. Predictors revealed as statistically significant were kept in the subsequent steps of analyses. Significance is denoted as follows: *p<0.05, **p<0.01, ***p<0.001. ^aThese predictors were included in the following steps, even when not being statistically significant, as they were rated as of potential clinical relevance. ^bIn the final analysis we used either any oral anti-diabetes medication, or any anti-inflammatory anti-diabetes medication, or any metformin-containing medication (see Results); the table shows the results for any anti-inflammatory anti-diabetes medication (see Table 2 for details).

Abbreviations: BMI, body mass index; ICS, inhaled corticosteroids; OCS, oral corticosteroids.

Table 3 Results of Logistic Regression Analyses in Either the Total Population of Patients or Those in GOLD Group D, Demonstrating the Significant Effect of Anti-Inflammatory Diabetes Medication in Both

Predictor	All Patients (N = 2222)				GOLD Group D (N = 515)
	OR	95% CI of OR		p value	OR	95% CI of OR		p value
		Lower	Upper			Lower	Upper
Demographics
Age (per 10 y)	1.182	1.012	1.380	0.035	1.386	1.037	1.852	0.028
Sex (female vs male)	2.829	2.184	3.663	<0.001	2.523	1.583	4.020	<0.001
BMI (kg/m^2)	0.942	0.917	0.967	<0.001	0.942	0.899	0.986	0.011
Smoking status (active)	0.850	0.625	1.156	0.300	0.794	0.410	1.538	0.494
Lung function
RV/TLC (%)	1.022	1.010	1.035	<0.001	1.013	0.989	1.036	0.286
Comorbidities
Asthma	1.643	1.232	2.190	0.001	1.309	0.782	2.190	0.306
Diabetes	1.371	0.813	2.311	0.237	2.158	0.979	4.760	0.057
Arterial hypertension	0.912	0.643	1.293	0.605	0.741	0.409	1.342	0.323
Cardiac disease	1.259	0.921	1.721	0.148	1.271	0.751	2.151	0.371
Medication
ICS	1.199	0.905	1.590	0.206	2.789	1.340	5.808	0.006
OCS	1.818	1.323	2.498	<0.001	1.857	1.141	3.024	0.013
Cardiac medication	1.723	1.173	2.531	0.006	1.546	0.784	3.049	0.208
Anti-inflammatory diabetes medication	0.358	0.166	0.773	0.009	0.183	0.054	0.619	0.006

Notes: Results for metformin were similar (p<0.05), while those for any oral anti-diabetes medication did not indicate a significant relationship to this medication (see Figure 1). In GOLD groups A, B, C and the pooled group ABC there were no significant relationships to any of the anti-diabetes medications.

Abbreviations: OR, odds ratio (= EXP[B]); 95% CI, respective 95% confidence interval; RV/TLC, ratio of residual volume to total lung capacity determined by body plethysmography; ICS, inhaled corticosteroids; OCS, oral corticosteroids.

Figure 1 Results of logistic regression analyses in either the total population of patients or those in GOLD group D, demonstrating the significant effect of anti-inflammatory diabetes medication in both.