Prevalence, risk factors, and health-related quality of life of osteoporosis in patients with COPD at a community hospital in Taiwan

Figures & data

Figure 1 Algorithm of the study.

Abbreviations: TB, tuberculosis; T, T-score.

Table 1 Clinical characteristics of COPD patient with and without osteoporosis

	Nonosteoporosis n=75	Osteoporosis n=50	P-value
Age, years, mean ± SD	71.7±7.2	73.6±7.7	0.173
Sex, male, n (%)	74 (98.7)	49 (98.0)	1.000
BMI, kg/m^2, mean ± SD	23.9±3.3	21.8±3.4	0.001
Smoking, n (%)
Never	3 (4.0)	4 (8.0)	0.414
Quit	37 (49.3)	28 (56.0)
Current	35 (46.7)	18 (36.0)
Smoking amount, pack-years, mean ± SD	45.8±27.0	49.4±30.6	0.490
BMD, mean ± SD
LS	1.11±0.14	0.905±0.159	<0.001
LFK	0.86±0.17	0.682±0.120	<0.001
RFK	0.87±0.16	0.689±0.121	<0.001
T-score	−1.169±0.81	−2.48±0.89	<0.001
Underlying disease, n (%)
DM	10 (13.3)	6 (12)	0.827
HTN	43 (57.3)	20 (40)	0.058
Hyperlipidemia	11 (14.7)	2 (4)	0.074
Alcohol	24 (32)	9 (18)	0.082
CAD	3 (4)	4 (8)	0.436
CHF	2 (2.7)	6 (12)	0.059
CKD	5 (6.7)	1 (2)	0.400
CLD	9 (12)	2 (4)	0.197
Education, n (%)			0.612
Illiterate	17 (22.7)	11 (22)
Elementary	33 (44)	29 (58)
Junior	5 (6.7)	3 (6)
Senior	11 (14.7)	5 (10)
College	7 (9.3)	2 (4)

Note: Education represents the highest academic degree of patient.

Abbreviations: BMI, body mass index; BMD, body mineral density; CAD, coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease mellitus; CLD, chronic liver disease; DM, diabetes mellitus; HTN, hypertension; LFK, left femoral neck; LS, lumbar spine; RFK, right femoral neck; SD, standard deviation.

Table 2 GOLD stage and pulmonary function in COPD patients with and without osteoporosis

	Nonosteoporosis n=75	Osteoporosis n=50	P-value
GOLD, n (%)			0.255
Stage I	8 (11)	5 (10)
Stage II	40 (53)	19 (38)
Stage III	24 (32)	21 (42)
Stage IV	3 (4)	5 (10)
GOLD, n (%)			0.024
Group A	30 (40)	13 (26)
Group B	12 (16)	8 (16)
Group C	17 (22.7)	6 (12)
Group D	16 (21)	23 (46)
Systolic BP, mmHg, mean ± SD	137±16	133±16	0.155
Diastolic BP (mmHg), mean ± SD	82±12	79±12	0.283
Heart rate/minute, mean ± SD	84±15	84±15	0.850
SpO2, %, mean ± SD	95±2	95±3	0.212
Pulmonary function
FVC, liters, mean ± SD	2.15±0.59	1.99±0.45	0.111
FVC, predicted %, mean ± SD	63.6±17	58.7±14	0.096
FEV1, liters, mean ± SD	1.28±0.45	1.07±0.37	0.007
FEV1, predicted %, mean ± SD	58.4±18	48.5±19	0.080
FEV1/FVC, mean ± SD	58.43±8.9	52.79±11.0	0.002
BD response, n (%)	13 (17.3)	9 (18)	0.924
MMEF, liters, mean ± SD	0.66±0.38	1.61±7.86	0.399

Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; BP, blood pressure; SD, standard deviation; SpO₂, oximetric oxygen saturation; FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; BD, bronchodilator; MMEF, maximum midexpiratory flow.

Table 3 Multivariate logistic regression analysis of factors for osteoporosis in COPD patients

Variables	B	SE	Odds ratio	95% CI for Odds ratio		P-value
				Lower	Upper
Smoking amount (pack-years)	0.008	0.007	1.008	0.995	1.022	0.229
Age (years)	0.020	0.028	1.020	0.965	1.078	0.476
BMI (kg/m^2)	−0.194	0.064	0.824	0.727	0.933	0.002
FEV1 (L/s)	−1.021	0.511	0.360	0.132	0.981	0.046
Constant	3.332	2.679	27.988			0.214

Abbreviations: CI, confidence interval; SE, standard error; BMI, body mass index; FEV₁, forced expiratory volume in 1 second.

Table 4 Health-related quality of life in COPD patients with and without osteoporosis

	Nonosteoporosis n=75	Osteoporosis n=50	P-value
mMRC, mean ± SD	1.4±0.8	1.7±0.8	0.046
mMRC grades			0.156
Grade 0, n (%)	5 (7)	2 (4)
Grade 1, n (%)	42 (56)	18 (38)
Grade 2, n (%)	22 (29)	21 (44)
Grade 3, n (%)	5 (7)	7 (15)
Grade 4, n (%)	1 (1)	0
mMRC ≥2, n (%)	28 (37.3)	28 (56)	0.045
SGRQ, mean ± SD	28.0±17.3	36.6±18.6	0.010
OCD, mean ± SD	5.4±1.6	4.8±1.8	0.045
CES-D, mean ± SD	11.7±8.0	13.6±8.6	0.434
CAT, mean ± SD	11.5±7	14.7±8	0.019

Notes: Two mMRC score data and one CES-D score data in osteoporosis patients were missing.

Abbreviations: mMRC, modified Medical Research Council; SD, standard deviation; SGRQ, St George’s Respiratory Questionnaire; OCD, oxygen-cost diagram; CES-D, Center for Epidemiologic Studies – depression; CAT, COPD Assessment Test.

Table 5 Prevalence and related risk factors of osteoporosis in COPD patients for the past decade worldwide

Study	Country	n	Osteoporosis (%)	Associated factors
Watanabe et al^Citation12	Japan	136	38.8% by BMDa, 79.4% by VCF	(+): FEV1, FVC, smoking
			83.7% by BMD and VCFb
Hattiholi and Gaude^Citation13	India	102	66.6% by BMD	(+): COPD stage, low BMI, AEs >3, steroids
Li et al^Citation14	USA	179	69% in African–Americans	(+): FVC/predicted FVC
			65% in Caucasians by BMD	(−): Sex, race
Silva et al^Citation15	Brazil	95	42.1% by BMD	(+): Low BMI, activity, BODE, FVC, FRV, IC, DLCO
				(−): Oral steroids, smoking, 6MWT
Rittayamai et al^Citation16	Thailand	102	31.4% by BMD	(+): BMI <20.5 kg/m^2 and hs-CRP >2.3 mg/L
				(−): COPD stage, age, smoking, and steroid use
Jørgensen et al^Citation17	Denmark	62	24% by VCF 42% by BMD	(−): Steroids, FEV1, FVC, smoking
Ferguson et al^Citation18 TORCH		658	23% by BMD	(−): ICS, fluticasone
Graat-Verboom et al^Citation19	the Netherlands	49	50% in GOLD-II by BMD and VCFb	(+): Low BMI, high RV/TLC
Graat-Verboom et al^Citation20	the Netherlands	90	47%–61% in 3 years by BMD and VCFb	(+): Low T-score in trochanter, vitamin D deficiency
				(−): Smoking

Notes:

a osteoporosis is defined by the measure of bone mineral density (BMD);

b osteoporosis is defined by both bone mineral density (BMD) and vertebral compression fracture (VCF). (+) A significant risk factor for osteoporosis and (−) not a significant risk factor for osteoporosis.

Abbreviations: BMD, bone mineral density; VCF, vertebral compression fracture; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; BMI, body mass index; AEs, acute exacerbation; BODE, BMI, obstruction (airflow), dyspnea (score), exercise (capacity); FRV, functional residual volume; IC, inspiratory capacity; D_LCO, diffusing capacity of the lungs for carbon monoxide; 6MWT, 6-minute walking test; hs-CRP, highly sensitive C-reactive protein; ICS, inhaled corticosteroids; TORCH, Towards a Revolution in COPD Health; GOLD, Global Initiative of Chronic Obstructive Lung Disease; TLC, total lung capacity.

WatanabeRTanakaTAitaKOsteoporosis is highly prevalent in Japanese males with chronic obstructive pulmonary disease and is associated with deteriorated pulmonary functionJ Bone Miner Metab Epub201475

 Web of Science ®Google Scholar

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

 PubMedGoogle Scholar

LiLBrennanKJGaughanJPCiccolellaDEKuzmaAMCrinerGJAfrican Americans and men with severe COPD have a high prevalence of osteoporosisCOPD20085529129718972277

 PubMedGoogle Scholar

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

 PubMed Web of Science ®Google Scholar

RittayamaiNChuaychooBSriwijitkamolAPrevalence of osteoporosis and osteopenia in Thai COPD patientsJ Med Assoc Thai20129581021102723061305

 PubMedGoogle Scholar

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

 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 BorneBERisk factors for osteoporosis in Caucasian patients with moderate chronic obstructive pulmonary disease: a case control studyBone20125061234123922426499

 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