Authors (including presenting author) :
Tseng, CZS(1), Yip ML(2), Ng LY(1), Yee KSW(1)
Affiliation :
(1) Respiratory Medicine Team, Medicine & Geriatrics, Kwong Wah Hospital (2) Tung Wah Group Hospital's Integrated Diagnostic & Medical Centre
Introduction :
Chronic Obstructive Pulmonary Disease (COPD) patients often suffer from extra-pulmonary conditions that affect their quality of life and survival. Osteoporosis is a well-known co-morbidity in COPD patients, and it poses a significant fracture risk. This is of particular importance as vertebral fractures can impair lung function and COPD patients are at increased operative risks. Despite increasing interest on the topic, prevalence of osteoporosis among COPD patients in Hong Kong remains unknown. It is likely under-detected and thus under-treated. As a chronic illness, there are effective treatment options available for osteoporosis. Early detection, as well as early intervention may significantly affect management and outcome in COPD patients.
Objectives :
1) To determine the prevalence of osteoporosis in COPD patients at a local hospital 2) Identify risk factors for osteoporosis in COPD patients.
Methodology :
A cross-sectional study conducted in Kwong Wah Hospital enrolling 111 patients between 50 to 80 years old with spirometry confirmed COPD. Exclusion criteria include non-COPD respiratory disorders, known metabolic bone disorders, or secondary causes of osteoporosis. Patients on long term systemic steroid or established osteoporosis were also excluded from the study. Prevalence of Osteoporosis and osteopenia in COPD patients were determined by Bone Mineral Density (BMD), measured by Dual Energy X-Ray Absorptiometry at the lumbar spine and hip.
Result & Outcome :
Among 111 COPD patients, 14(12.6%) patients were osteoporotic, 64 patients (57.7%) had osteopenia, while 33(29.7%) had normal BMD. Compared with non-osteoporotic COPD patients, COPD patients with osteoporosis were characterized by a lower BMI(19.72 ± 3.62 vs 22.94 ± 4.7, p = 0.016), less years quitted smoking(7.88 ± 4.73 vs 12.19 ± 8.86, p = 0.014), more commonly on high dose Inhaled Corticosteroid[ICS] (14.3% Vs 2%, p = 0.022), on a Proton-Pump Inhibitor[PPi] (42.8% Vs 13.4%, p = 0.018), lower FEV1/FVC%(43.36 ± 7.98 vs 48.94 ± 12.33, p = 0.034), FEV1 in liters(0.89 ± 0.44 vs 1.25 ± 0.56, p = 0.026), FVC in liters(2.03 ± 0.76 vs 2.50 ± 0.78, p = 0.039), higher modified Borg dyspnoea scale (6.64 ± 2.02 vs 4.86 ± 2.072, p = 0.003), and higher CAT score (16.07 ± 6.51 vs 12.09 ± 6.06, p = 0.025). However, in a multivariate regression analysis, only the use of a PPi (odds ratio[OR] 4.781, 95% confidence interval [95% CI] 1.135 – 2.129; p = 0.033) and BMI (OR 0.760, 95% CI 0.614 – 0.939; p = 0.011) were significantly associated with risk of osteoporosis in COPD.
