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High vertebral fracture rate documented in COPD patients

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PHOENIX, AZ (Reuters Health) – Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for vertebral fractures, investigators announced here at the 23rd Annual Meeting of the American Society for Bone and Mineral Research.

Dr. Alexander Papaioannou and associates at McMaster University in Hamilton, Canada, conducted a case-control study of 149 randomly identified COPD patients and 145 age- and sex-matched control patients who did not have a diagnosis of COPD or asthma. All subjects had had a lateral-anterior/posterior chest radiograph and had been admitted to an acute care hospital during a recent 12-month period.

The investigators determined outcomes using a chart review to identify diagnoses, medication use, and chest radiograph interpretations. The results showed that 15 COPD patients, or 10.1%, had sustained a vertebral fracture that was confirmed by radiograph compared with three (2.1%) controls.

The prevalence of either vertebral fracture or osteopenia was 17.4% in COPD patients and 8.9% in controls. Among the 18 patients and controls found by the study radiologists to have vertebral fractures, seven (38.8%) had a diagnosis of osteoporosis recorded in their medical charts.

Dr. Papaioannou suggested that the high use of corticosteroid therapy in the COPD cases may play an important role in the higher prevalence of vertebral fractures. "Indeed our findings support such a relationship," he said. The percentage of patients exposed to either oral or inhaled corticosteroids at the time of admission was 73.2% in cases and 4.1% in controls.

Only four (16.6%) of the fracture patients were discharged on bisphosphonates or hormone replacement therapy. Dr. Papaioannou noted that this low percentage may be attributable to the fact that osteoporosis and vertebral fractures were underreported in discharge summaries and chest X-ray interpretations.

Finally, he said the data suggest that COPD patients should be targeted for prevention and treatment of osteoporosis-related fractures.

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