Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma.
CONCLUSIONS
In 5,541 community dwelling men, chronic obstructive pulmonary disease, or asthma was associated with lower bone mineral density (BMD) at the spine and total hip and an increased risk of vertebral and nonvertebral fractures independent of age, body mass index, and smoking. Men prescribed with corticosteroids had the lowest BMD.


BACKGROUND
It is unclear whether chronic obstructive pulmonary disease (COPD) is independently associated with BMD and fractures.


METHODS
In 5,541 men from the Osteoporotic Fractures in Men Study, history of COPD or asthma, current treatment with corticosteroids, BMD, bone loss after 4.5 years and fractures were ascertained.


RESULTS
Seven hundred fourteen (13%) men reported COPD or asthma, of which 103 were prescribed an oral steroid and 177 an inhaled steroid. Independent of confounders, men prescribed corticosteroids for COPD or asthma had the lowest BMD and a 2-fold increased risk of vertebral osteoporosis compared to men with no history of COPD or asthma (OR 2.13, 95% CI (confidence interval) 1.15-3.93 oral steroids; OR 2.05, 95% CI 1.27-3.31 inhaled steroids). During follow-up, BMD increased at the spine, but there was no difference in bone loss at the hip. However, men with COPD or asthma had a 2.6- and 1.4-fold increased risk of vertebral and nonvertebral fractures, respectively.


CONCLUSIONS
Chronic obstructive pulmonary disease or asthma was associated with lower BMD at the spine and hip and increased risk of vertebral and nonvertebral fractures independent of age, clinic site, BMI, and smoking. A history of COPD or asthma may be a useful clinical risk factor to identify patients with osteoporosis.
Dam
T-T
TT
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA. td2265@columbia.edu.edu
Harrison
S
S
Fink
H A
HA
Ramsdell
J
J
Barrett-Connor
E
E
D000280:Administration, Inhalation; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D005272:Femur Neck / Q000503:physiopathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology
D005938:Glucocorticoids