title: Mortality associated with bone fractures in COPD patients.
abstract: OBJECTIVE
  COPD is well known to frequently coexist with osteoporosis. Bone fractures often occur and may affect mortality in COPD patients. However, in-hospital mortality related to bone fractures in COPD patients has been poorly studied. This retrospective study investigated in-hospital mortality of COPD patients with bone fractures using a national inpatient database in Japan.
  
  
  METHODS
  Data of COPD patients admitted with bone fractures, including hip, vertebra, shoulder, and forearm fractures to 1,165 hospitals in Japan between July 2010 and March 2013, were extracted from the Diagnosis Procedure Combination database. The clinical characteristics and mortalities of the patients were determined. Multivariable logistic regression analysis was also performed to determine the factors associated with in-hospital mortality of COPD patients with hip fractures.
  
  
  RESULTS
  Among 5,975 eligible patients, those with hip fractures (n=4,059) were older, had lower body mass index (BMI), and had poorer general condition than those with vertebral (n=1,477), shoulder (n=281), or forearm (n=158) fractures. In-hospital mortality was 7.4%, 5.2%, 3.9%, and 1.3%, respectively. Among the hip fracture group, surgical treatment was significantly associated with lower mortality (adjusted odds ratio, 0.43; 95% confidence interval, 0.32-0.56) after adjustment for patient backgrounds. Higher in-hospital mortality was associated with male sex, lower BMI, lower level of consciousness, and having several comorbidities, including pneumonia, lung cancer, congestive heart failure, chronic liver disease, and chronic renal failure.
  
  
  CONCLUSIONS
  COPD patients with hip fractures had higher mortality than COPD patients with other types of fracture. Surgery for hip fracture was associated with lower mortality than conservative treatment.
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamauchi
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Yukiyo
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Wakae
authors.initials: W
authors.lastname: Hasegawa
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takeshima
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Urushiyama
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine; Department of Health Services Research, Graduate School of Medicine, The University of Tokyo.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Jo
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Takahide
authors.initials: T
authors.lastname: Nagase
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005592:Fracture Fixation; D006304:Health Status; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D065840:Protective Factors; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
keywords: COPD; hip fractures; in-hospital mortality; surgical treatment