COPD and osteoporosis: links, risks, and treatment challenges

Figures & data

Table 1 Prevalence of osteoporosis defined by BMD and vertebral fracture evaluated by X-ray exams

Study	N	Sex (M/F)	Age (years)	BMI (kg/cm^2)	FEV1 %pred	Osteopenia by BMD	Osteoporosis by BMD	Vertebral fracture	Details
Graat-Verboom et al^Citation6	775	67/33	63	24.9	46.7	27%–67%	9%–69%	–	A systematic review of osteoporosis (defined by BMD) in COPD including13 studiesa
Watanabe et al^Citation7	136	136/0	71	21.5	55.8	43% (21/49)b	39% (19/49)b	79%	Patients in a Japanese general hospital, including 17% patients with past oral and/or intravenous corticosteroid use
Graat-Verboom et al^Citation10	255	158/97	68	27.1	64.0	46%	24%	37%	Clinically stable COPD patients including 23 patients with oral corticosteroids Osteoporosis defined by BMD and X-ray: 51%
Ferguson et al^Citation39	658	382/276	65	26.7	44.0	42%	23%	–	Outpatients of TORCH study whose BMD data were available, including191 patients with a history of oral corticosteroid use
Graat-Verboom et al^Citation40	133	80/53	69	26.8	63.4	48%	22%	32%	Clinically stable outpatients, including 16 patients with chronic oral corticosteroids Osteoporosis defined by BMD and X-ray: 47%
Silva et al^Citation42	95	62/33	67	25.8	41.0	42%	42%	–	Outpatients at a general, tertiary-care, university-affiliated hospital, including34 patients with a history of oral corticosteroid use
Ogura-Tomomatsu et al^Citation50	85	78/7	75	–	–	22%	24%	35%	Patients referred to a pulmonary clinic, including nine patients with oral corticosteroid use
Hattiholi and Gaude^Citation43	102	64/38	66	–	–	20%	67%	–	Outpatients at a tertiary-care hospital
Carter et al^Citation14	350	350/0	68	–	–	–	–	52%	Patients with symptomatic COPD episodes. Another radiologist reported a fracture rate of 5.4%
Jorgensen et al^Citation28	62	16/46	63	–	32.6	30%	41%	24% (3/15)c	Patients with severe airflow limitation aged between 50 and 70 years, including nine patients with continuous oral glucocorticoids treatment
McEvoy et al^Citation46	312	312/0	69	–	52.7	–	–	Thoracic/lumbar: 49%/17%	Outpatients using inhaled β-agonists or corticosteroids, including 125 patients with systemic corticosteroids
Papaioannou et al^Citation47	127	–	72	–	32.5	–	–	27%	Patients admitted to an acute care hospital, including patients with oral(74.7%) or inhaled (86.6%) corticosteroids
Nuti et al^Citation48	3,030	1,778/1,262	70	27.0	–	–	–	41%	Clinically stable outpatients. Only chest X-rays were evaluated
Kjensli et al^Citation49	465	231/234	63	25.0	45.0	–	–	31%	Admitted COPD patients attending a 4-week rehabilitation program, including 201 patients with a history of oral corticosteroid use
Katsura and Kida^Citation37	20	0/20	72	22.0	49.9	–	50%	40%	Postmenopausal COPD patients without a history of chronic systemic corticosteroid use

Notes:

a The 13 studies analyzed in the systematic review by Graat-Verboom et al⁶ have been excluded from the table. (–), not reported in the original paper.

b BMD was measured only in 49 subjects.

c Fracture was evaluated only in 15 subjects.

Abbreviations: N, the number of subjects; M/F, males/females; BMI, body mass index; FEV₁, forced expiratory volume in 1 second; %pred, percent of the predicted value; BMD, bone mineral density; COPD, chronic obstructive pulmonary disease; TORCH, TOwards a Revolution in COPD Health.

Table 2 Bone changes in COPD

Low BMD
Impaired bone quality
Decreased TBS
Increased cortical porosity
Low bone turnover
Suppressed bone formation

Abbreviations: BMD, bone mineral density; TBS, trabecular bone score.

Table 3 Risk factors of osteoporosis in COPD

General/common
Older age
Smoking
Low BMI
Reduced physical activity
Disease-specific
Systemic inflammation
Pulmonary dysfunction
Glucocorticoid use
Vitamin D insufficiency/deficiency

Abbreviations: COPD, chronic obstructive pulmonary disease; BMI, body mass index.

Table 4 Evaluation of fracture risk

Routine medical interview
Clinical risk factors for FRAX
Severe pulmonary dysfunction
Reduced physical activity
Height loss
Spine X rays (and/or CT)
Prevalent vertebral fracture
DXA
Hip BMD

Abbreviations: FRAX, fracture assessment tools; CT, computed tomography; DXA, dual energy X-ray absorptiometry; BMD, bone mineral density.

Table 5 Treatment of osteoporosis in COPD

Lifestyle modifications
Smoking cessation
Exercise/physical training
Pharmacological treatment
Vitamin D and calcium
Bisphosphonate
Denosumab
Teriparatide
SERMs

Abbreviation: SERMs, selective estrogen receptor modulators.

Graat-VerboomLWoutersEFSmeenkFWCurrent status of research on osteoporosis in COPD: a systematic reviewEur Respir J200934120921819567604

 PubMed Web of Science ®Google Scholar

WatanabeRTanakaTAitaKOsteoporosis is highly prevalent in Japanese males with chronic obstructive pulmonary disease and is associated with deteriorated pulmonary functionJ Bone Miner Metab201533439240024996527

 PubMed Web of Science ®Google Scholar

Graat-VerboomLvan den BorneBESmeenkFWSpruitMAWoutersEFOsteoporosis in COPD outpatients based on bone mineral density and vertebral fracturesJ Bone Miner Res201126356156820878771

 PubMed Web of Science ®Google Scholar

FergusonGTCalverleyPMAndersonJAPrevalence and progression of osteoporosis in patients with COPD: results from the towards a revolution in COPD Health studyChest200913661456146519581353

 PubMed Web of Science ®Google Scholar

Graat-VerboomLSmeenkFWvan den BorneBEProgression of osteoporosis in patients with COPD: a 3-year follow up studyRespir Med2012106686187022369986

 PubMed Web of Science ®Google Scholar

SilvaDRCoelhoACDumkeAOsteoporosis prevalence and associated factors in patients with COPD: a cross-sectional studyRespir Care201156796196821352667

 PubMed Web of Science ®Google Scholar

Ogura-TomomatsuHAsanoKTomomatsuKPredictors of osteoporosis and vertebral fractures in patients presenting with moderate-to-severe chronic obstructive lung diseaseCOPD20129433233722489911

 PubMedGoogle Scholar

HattiholiJGaudeGSPrevalence and correlates of osteoporosis in chronic obstructive pulmonary disease patients in IndiaLung India201431322122725125807

 PubMedGoogle Scholar

CarterJDPatelSSultanFLThe recognition and treatment of vertebral fractures in males with chronic obstructive pulmonary diseaseRespir Med200810281165117218562189

 PubMed Web of Science ®Google Scholar

JorgensenNRSchwarzPHolmeIThe prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional studyRespir Med2007101117718516677808

 PubMed Web of Science ®Google Scholar

McEvoyCEEnsrudKEBenderEAssociation between corticosteroid use and vertebral fractures in older men with chronic obstructive pulmonary diseaseAm J Respir Crit Care Med19981573 Pt 17047099517579

 PubMed Web of Science ®Google Scholar

PapaioannouAParkinsonWFerkoNPrevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in CanadaOsteoporos Int2003141191391714551675

 PubMed Web of Science ®Google Scholar

NutiRSivieroPMaggiSVertebral fractures in patients with chronic obstructive pulmonary disease: the EOLO StudyOsteoporos Int200920698999818931817

 PubMed Web of Science ®Google Scholar

KjensliAFalchJARygMHigh prevalence of vertebral deformities in COPD patients: relationship to disease severityEur Respir J20093351018102419129288

 PubMed Web of Science ®Google Scholar

KatsuraHKidaKA comparison of bone mineral density in elderly female patients with COPD and bronchial asthmaChest200212261949195512475832

 PubMed Web of Science ®Google Scholar