Osteoporosis Is Risk Factor for Mortality in Non-Cystic Fibrosis Bronchiectasis

Osteoporosis is an independent risk factor for all-cause mortality in hospitalized patients with non-cystic fibrosis bronchiectasis (NCFB), according to a study in BMC Pulmonary Medicine.

Because research indicates that osteoporosis affects lung function and outcomes in patients with chronic obstructive pulmonary disease (COPD), researchers sought to determine the extent to which NCFB outcomes were likewise affected by osteoporosis. The researchers therefore investigated the prognostic effect of osteoporosis in hospitalized patients with NCFB and identified clinical risk factors for osteoporosis in this population.

The observational cohort study was conducted at the pulmonary and critical care department of a hospital in Southeast China from September 2017 to December 2021. Investigators enrolled 179 hospitalized patients with bronchiectasis and respiratory symptoms who had NCFB (mean [SD] age, 64.19 [14.12] years). Among those patients, 38 had osteoporosis (median age, 74 years; 34% male), and 141 were without osteoporosis (median age, 64 years; 58% male).

Of the cohort, 154 patients completed the Chronic Airway Assessment Test (CAT) and St. George Respiratory Questionnaire (SGRQ) evaluation. Patients with osteoporosis had significantly increased CAT scores (22.0 vs 17.0) and SGRQ scores (42 vs 27) compared with those without osteoporosis. The Bronchiectasis Severity Index (BSI) scores and Bronchiectasis Aetiology Comorbidity Index (BACI) scores were significantly higher in patients with vs without osteoporosis (14 vs 11 for BSI and 5 vs 4 for BACI).

The patients with osteoporosis were likely to be older, female, and have cardiovascular disease (CVD), gastroesophageal reflux disease, anemia, postinfection, and regular inhaled corticosteroid (ICS) treatment. Modified Poisson regression analysis showed that age (relative ratio [RR], 1.03), female sex (RR, 2.77), anemia (RR, 2.22), subsequent infection (RR, 1.78), and regular ICS treatment (RR, 3.05) were independent risk factors associated with osteoporosis in hospitalized patients with NCFB.

After a median follow-up of 32 months, 21 (11.73%) patients died. Multivariate regression analysis showed that the BSI score, comorbid osteoporosis, PAH, CVD, and cerebrovascular disease were independently associated with all-cause mortality. The all-cause mortality rate was significantly higher in patients with NCFB and osteoporosis (28.94%; 11/38) vs without osteoporosis (7.09%; 10/141; hazard ratio [HR] 5.34, 95% CI, 2.26-12.67; P <.001).

After adjustment for BSI and other confounding factors, hospitalized patients with NCFB with osteoporosis vs without osteoporosis had an HR of 4.29 (95% CI, 1.75-10.49).

Limitations include the observational, single-center design and the inclusion of only hospitalized patients in the study population. In addition, the level of 1,25 dihydroxyvitamin D or any other factor that has an association between osteoporosis and NCFB was not assessed.

“Age, female sex, history of infection, anemia, and regular ICS treatment were risk factors associated with osteoporosis in hospitalized NCFB patients from Asia,” concluded the investigators. “Our study indicates that comorbid osteoporosis in hospitalized NCFB patients is an independent risk factor for all-cause mortality. Clinicians should pay attention to bone health in patients with chronic pulmonary disease, including bronchiectasis.”