Prevalence and Risk Factors for Osteoporosis in Individuals With COPD: A Systematic Review and Meta-analysis

doi:10.1016/j.chest.2019.06.036

Chest

Volume 156, Issue 6, December 2019, Pages 1092-1110

The abstract of this systematic review has been presented at the American Thoracic Society 2018 International Conference, May 18-23, 2018, San Diego, CA. Part of this article has been presented in abstract form (Chen YW, Ramsook AH, Coxson HO, Bon J, Reid WD. Am J Respir Crit Care Med. 2018;197:A1720).

https://doi.org/10.1016/j.chest.2019.06.036 Get rights and content

Background

Osteoporosis is prevalent in individuals with COPD. Updated evidence is required to complement the previous systematic review on this topic to provide best practice. The aim of this systematic review and meta-analysis was to quantitatively synthesize data from studies with respect to the prevalence and risk factors for osteoporosis among individuals with COPD.

Methods

EMBASE, CINAHL, MEDLINE, and PubMed databases were searched for articles containing the key words “COPD,” “osteoporosis,” “prevalence,” and “risk factor.” Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine osteoporosis prevalence and risk factors in individuals with COPD. Meta-regression analyses were conducted to explore the sources of heterogeneity.

Results

The pooled global prevalence from 58 studies was 38% (95% CI, 34-43). The presence of COPD increased the likelihood of having osteoporosis (OR, 2.83). Other significant risk factors for osteoporosis in COPD patients were BMI < 18.5 kg/m² (OR, 4.26) and the presence of sarcopenia (OR, 3.65).

Conclusions

Osteoporosis is prevalent in individuals with COPD, and the prevalence seems to be high and similar in many countries. Patients with COPD should be screened for osteoporosis and contributing risk factors.

Section snippets

Search Strategy

The protocol for this systematic review was registered on PROSPERO (CRD42017067485). Four databases (EMBASE, CINAHL, MEDLINE, and PubMed) were searched from their inception to January 22, 2018. To define the population, “chronic obstructive pulmonary disease” was combined by the Boolean operator “AND” with terms that potentially evaluated osteoporosis; that is, “osteoporosis,” “bone mineral density,” “dual-energy X-ray absorptiometry,” and “computed tomography.” To determine the prevalence and

Study Selection

The initial search produced 4,957 articles. After excluding duplicates, the titles and abstracts of 1,926 articles were screened for eligibility. Of these, the full-text of 116 articles was screened for eligibility, resulting in the identification of 58 studies that were reported in 64 publications13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62,

Discussion

This review quantitatively synthesized the current evidence on the prevalence and risk factors for osteoporosis in COPD in 58 studies with 8,753 participants with COPD to demonstrate a pooled global prevalence of 38%. The prevalence of osteoporosis did not significantly differ (P = .49) among the five regions in the world. In addition to COPD, significant risk factors were BMI < 18.5 kg/m², decreased FFMI values, and the presence of sarcopenia.

This study found that patients with COPD have a

Conclusions

This systematic review and meta-analysis revealed that osteoporosis is a prevalent comorbidity worldwide in patients with COPD. Low BMI and low muscle mass are associated with this increased prevalence. Individuals with COPD at high risk for osteoporosis should be identified early through screening, and strategies aimed at improving or controlling risk factors for osteoporosis should be implemented in the early stages of lung disease.

Acknowledgments

Author contributions: Y.-W. C. is the guarantor of the content of the manuscript, including the data and analysis. Y.-W. C., H. O. C., and W. D. R. conceived and designed the research questions. Y.-W. C. and A. H. R. performed the search, quality assessment, and extraction of the data. Y.-W. C. analyzed the data and drafted the manuscript, and all the authors interpreted the data. A. H. R., J. B., H. O. C., and W. D. R. edited and provided critical revision of the manuscript. All the authors

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Chest

Original Research: COPDPrevalence and Risk Factors for Osteoporosis in Individuals With COPD: A Systematic Review and Meta-analysis

Background

Methods

Results

Conclusions

Section snippets

Search Strategy

Study Selection

Discussion

Conclusions

Acknowledgments

Transplant Proc

Respir Med

Artery Res

Chest

Egypt J Chest Dis Tuberc

Pulm Pharmacol Ther

J Clin Densitom

Respir Med

Bone

Respir Med

Chest

Respir Med

Chest

Bone

Am J Transplant

Transplant Proc

Bone

Am J Med

Respir Med

Clin Nutr

Respir Med

Chest

Chest

Systemic manifestations and comorbidities of COPD

Eur Respir J

Systemic effects of chronic obstructive pulmonary disease: what we know and what we don't know (but should)

Proc Am Thorac Soc

Osteoporosis: part I. Evaluation and assessment

Am Fam Physician

Hospital admissions and mortality in patients with COPD exacerbations and vertebral body compression fractures

Int J Chron Obstruct Pulmon Dis

Reduced pulmonary function in patients with spinal osteoporotic fractures

Osteoporos Int

The association between osteoporotic fractures and health-related quality of life as measured by the Health Utilities Index in the Canadian Multicentre Osteoporosis Study (CaMos)

Osteoporos Int

Current status of research on osteoporosis in COPD: a systematic review

Eur Respir J

Quality assessment tool for observational cohort and cross-sectional studies

Transformations related to the angular and the square root

Ann Math Stat

Country groupings

A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis

J Am Stat Assoc

Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis

Biometrics

Prevalence of osteoporosis and its risk factors in men with COPD in Qazvin

Int J Chronic Dis

Prevalence of osteoporosis and osteopenia in advanced chronic obstructive pulmonary disease patients

Lung India

Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Circulating matrix metalloproteinase-9 and osteoporosis in patients with chronic obstructive pulmonary disease. Chronic respiratory disease

Chron Respir Dis

Plasma inflammatory mediators associated with bone metabolism in COPD

COPD

Polymorphism of LRP5 gene and emphysema severity are associated with osteoporosis in Japanese patients with or at risk for COPD

Respirology

Predictors of low bone mineral density in elderly males with chronic obstructive pulmonary disease: the role of body mass index

Aging Male

Bone loss in patients with untreated chronic obstructive pulmonary disease is mediated by an increase in bone resorption associated with hypercapnia

J Bone Miner Res

Low bone mineral density in men with chronic obstructive pulmonary disease

Respir Res

A study of chronic obstructive pulmonary disease-specific causes of osteoporosis with emphasis on the emphysema phenotype

Ann Thorac Med

Assessment of bone mineral density in male patients with chronic obstructive pulmonary disease by DXA and quantitative computed tomography

Int J Endocrinol

Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D

Original Research: COPD
Prevalence and Risk Factors for Osteoporosis in Individuals With COPD: A Systematic Review and Meta-analysis