Background/Purpose: Chronic obstructive pulmonary disease (COPD) is usually considered as a risk factor for osteoporosis. However, COPD is an heterogeneous disease with different phenotypes, based on clinical and/or pulmonary function test classification. Our objectives are (1) to analyze the efficiency of a systematic osteoporosis screening in a COPD population (2) to analyze the clinical risk factor for OP in this population and (3) to correlate pulmonary function tests with bone parameters.

Methods: 90 consecutive COPD patients followed in pneumology ambulatory care were systematically included to have DEXA, VFA, blood analysis and pulmonary functiontests.

Results: 62% of the COPD patients were male, with a median BMI of 24.1kg/m2(14.5-44). 69% had a frequent use of glucocorticoids (maintenance inhaled or systemic and > 2 courses of systemic). 44% were active smokers. 26% of the COPD patients were identified as osteoporotic and VFA demonstrated an unknown vertebral fracture in 9%. Anti-osteoporotic drug was prescribed (or modified) in 32% after bone status investigation.  

A low BMI was strongly associated with a low bone mineral density (BMD) and osteoporotic condition in lumbar spine, femoral neck and total hip (p< 0.0001). Active smokershad significant lower BMD and were more osteoporotic than ex-smokers at the three sites studied (p< 0.01). Female gender was associated to lower BMD for total hip and femoral neck only. Biologic bone turnover and D-vitamin levels were not associated with BMD, while glucocorticoid use (as defined by the FRAX) was only associated to total hip osteoporosis.  

COPD severity based on FEV1 and FEV1/FVC ratio were not associated with bone weakness, with no link between FEV1 stratification and BMD. However, COPD phenotype modulated the bone strength: patients with complete emphysematous status (DLCO< 70%, DLCO/VA< 80% and CPT >115%) had significant lower BMD at lumbar spine, femoral neck and total hip (p< 0.05), with more osteoporosis at the hip (p< 0.01) and less normal condition (versus osteopenic and osteoporotic) at the lumbar spine and the femoral neck (p< 0.01). Of interest, there were more vertebral fracture on VFA and more history of hip fracture when DLCO was < 70%.

Conclusion: (1) Systematic screening for osteoporosis in COPD patients is efficient, with osteoporosis detection in 1/4, new vertebral fracture in 1/10 and a therapeutic intervention with anti-osteoporotic drug prescription in 1/3.
(2) Low BMI and active smoking were associated to osteoporosis in COPD patients. (3) COPD severity was not associated with bone loss, while the emphysematous status (association of 3 functional emphysematous characteristics: DLCO< 70%, DLCO/VA< 80% and CPT >115%) was correlated to bone weakness and osteoporosis. The “pink puffer” phenotype in COPD is at high risk for osteoporosis and should be particularly screened.

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/systematic-osteoporosis-screening-in-chronic-obtructive-pulmonary-disease-study-of-correlation-between-pulmonary-functions-tests-and-bone-parameters-emphysematous-status-is-linked-to-low-bone-densi/