PURPOSE: To determine the prevalence of densitometric osteoporosis (OP) and osteoporotic vertebral fractures in COPD patients. To identify the risk factors for the presence of OP and vertebral fractures in COPD patients.
METHODS: Inclusion criteria: Male sex, older than 50, COPD defined according to ATS/ERS classification. Patients’ informed consent to participate in the study. Exclusion criteria: Patients with COPD presenting any other concomitant pulmonary disease. Patients with COPD presenting rheumatologic and/or vertebral disease that may hinder the interpretation of the densitometry.Bone mass measurement was determined by dual-energy x-ray absorptiometry (DXA) at lumbar and femoral sites. OP was defined using the WHO score. X-ray of lumbar and dorsal spine was performed in order to evaluate the presence of vertebral fractures. Analytical parameters that influence the phospho-calcium metabolism were determined: calcemia, phosphoremia, 25-OHD3, PTH, alkaline phosphatases and testosterone. For each patient, age, weight, height, body mass index (BMI), comorbidities, toxins (cigarettes, alcohol), medications, degree of exposure to sun and daily calcium intake were recorded. Corticoesteroids treatments in previous five years and number of hospitalizations were also recorded.
RESULTS: 217 patients were evaluated. Mean age was 66.78 (50-84). 73 patients had a FEV1 between 50-80% and 138 had a FEV1<50%. Prevalence of OP and fractures were respectively 41.6% and 33%. Dose of prednisone greater than 675 mg, BMI below 21, low blood levels of vitamin D, and FEV1< 30% were associated significantly with OP (p<0.05). When logistic regression was performed only BMI (OR=0.9; 95% CI, 0.84-0.96) and FEV1<30% (OR=3.32; 95% CI, 1.36-8.06) remained in the model. Age, use of corticosteroid and FEV1<30% were associated significantly with vertebral fractures. When logistic regression was performed age (OR=1.06; 95% CI, 1.01-1.1) and FEV1<30% (OR=4.39; 95% CI, 1.66-11.59) remained in the model.
CONCLUSION: Prevalence of OP and vertebral fractures are higher than expected in general population. COPD severity is an important risk factor for OP and vertebral fracture.
CLINICAL IMPLICATIONS: Due to the high prevalence of OP and vertebral fractures, COPD patients should be routinely assessed for OP.
DISCLOSURE: Miguel Gallego, None.