Rapid Bone Mineral Density Declines Increase Vertebral Fracture Risk in COPD

Doctor reviewing bone density scan
In elderly patients with COPD, rapid decline in bone mineral density is associated with an increased risk for vertebral fracture.

In elderly patients with chronic obstructive pulmonary disease (COPD), rapid decline in bone mineral density (BMD) is associated with an increased risk for vertebral fracture, according to study results published in Respiratory Medicine.

Men and women (mean age, 72.5±8.1 years) diagnosed with COPD or at risk for COPD and who had annual BMD measurements in 3 body parts ≥3 times during a 3-year period were enrolled (N=111) in the study. Researchers assessed associations between bisphosphonate treatment and BMD decline, including in patients in a separate analysis who were not treated with this therapy at baseline but started  and continued therapy during follow-up (n=41).

At the time of study enrollment and every year thereafter, the researchers obtained a full medical and smoking history and information on pharmacologic treatment, disease exacerbations, and comorbid conditions. An exacerbation of COPD was defined as the need for systemic corticosteroids or antibiotics or hospitalization.

No difference was observed between the 2 groups in terms of rapid decliners (n=33) and nonrapid decliners (n=78) in terms of BMD at enrollment. Despite this lack of difference at baseline, rapid decliners had more vertebral fractures during a 3-year period compared with nonrapid decliners (20.7% vs 5.6%, respectively; P =.02). Compared with non-rapid decliners, rapid decliners were older (71.2±8.0 years vs 75.4±7.6 years, respectively; P =.01), had a lower body mass index (23.9±3.2 kg/m2 vs 22.6±2.4 kg/m2, respectively; P =.03), were less likely to engage in daily exercise (20.8% vs 36.7%, respectively; P =.09), and more likely to have anemia (11.5% vs 39.4%, respectively; P <.01).

Patients who initiated bisphosphonate and continued treatment demonstrated higher annual changes in BMD compared with patients who were not treated with bisphosphonate (lumbar spine: 2.30% vs 0.59%; P <.0001; right femur: 0.33% vs −0.34%; P <.0001; left femur: −0.17% vs −0.42%; P =.008).

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The small number of women in the study (5.4%), small sample size, and small number of patients who used medication to improve BMD were some of the study’s limitations.

Based on their findings, the researchers suggested that “bisphosphonate might modify BMD decline for the nested group of patients with COPD.”


Kameyama N, Chubachi S, Sasaki M, et al. Predictive and modifying factors of bone mineral density decline in patients with COPD. Respir Med. 2019;148:13-23.