Chronic obstructive pulmonary disease and fracture risk

  • Akyea RK & al.
  • BMJ Open
  • 3 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Patients with chronic obstructive pulmonary disease (COPD) are at an increased risk for fracture and despite this, there is no systematic assessment of fracture risk in these patients.
  • Fracture risk prediction tools identify patients with COPD at increased risk for fracture.

Why this matters

  • The Global Initiative for COPD strategy recommends that co-existence of osteoporosis should be considered in COPD, and the UK National Institute for Health and Care Excellence osteoporosis guidelines consider COPD as a secondary cause of osteoporosis encouraging the use of fracture prediction tools.

Study design

  • Study included 80,874 participants with COPD and 308,999 without COPD using UK primary health care records from The Health Improvement Network database.
  • Incidence of hip alone and all MOFs, accuracy of fracture prediction tools and prevalence and incidence of coded osteoporosis were assesed.
  • Funding: COPD ‘Open Air’ research.

Key results

  • Patients with COPD vs those without were at an increased risk for hip alone (HR, 1.67; 95% CI, 1.56-1.80) and MOFs (HR, 1.60; 95% CI, 1.52-1.69), which was largely mediated through oral corticosteroid use, body mass index and smoking.
  • Both FRAX and QFracture risk prediction tools showed similar accuracy for hip fracture (receiver operating characteristic [ROC] curve, 76.1%; 95% CI, 74.9-77.2%).
  • FRAX tool had higher accuracy for MOF vs QFracture tool (ROC curve, 71.4% [95% CI, 70.6-72.2%] vs 61.4% [95% CI, 60.5-62.3%]).
  • Compared with those without COPD, patients with COPD had higher prevalence (5.7% vs 3.9%; P<.001 and incidence of coded osteoporosis ci>


  • Incidence of osteoporosis based on clinical codes reflects an underestimation of the true risk for osteoporosis.

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