J Bone Metab.  2017 Nov;24(4):241-248. 10.11005/jbm.2017.24.4.241.

Prevalence of Osteoporosis in Korean Patients with Chronic Obstructive Pulmonary Disease and Their Health-related Quality of Life According to the Korea National Health and Nutrition Examination Survey 2008–2011

• Lee SH
• Kwon HY

• KMID: 2397558
• DOI: http://doi.org/10.11005/jbm.2017.24.4.241

Abstract

BACKGROUND
In this study, we evaluated the prevalence of osteoporosis, risk factors associated with osteoporosis, and health-related quality of life (HRQOL) in clinically stable chronic obstructive pulmonary disease (COPD) patients.
METHODS
A total of 1,081 COPD patients were recruited from the Korea National Health and Nutrition Examination Survey (KNHANES) from July 2008 to May 2011. Bone mineral densities at the lumbar spine, femoral neck, and total proximal femur were measured using dual energy X-ray absorptiometry. HRQOL was assessed using the EuroQOL-5 dimensions (EQ-5D) questionnaire. To identify factors associated with osteoporosis and HRQOL in patients with COPD, multivariate regression analyses was performed.
RESULTS
Of the 1,081 COPD patients, 191 (17.7%) were diagnosed with osteoporosis. There were significant differences in age, sex, smoking status, education level, house income, and body mass index (BMI) between the osteoporotic and non-osteoporotic groups. COPD patients with osteoporosis had significantly lower EQ-5D scores than the controls. In multivariate analyses, older age (odds ratio [OR]=1.10, P < 0.001) was risk factor for osteoporosis. And patients of male sex (OR=0.06, P < 0.001), high house income (OR=0.75, P=0.045), and high BMI (OR=0.74, P < 0.001) were less likely to have osteoporosis. In addition, osteoporosis was associated with poor HRQOL (β=−0.21, P=0.023).
CONCLUSIONS
The prevalence of osteoporosis in COPD patients based on the 2008 to 2011 KNHANES data were relatively lower than that in physician-diagnosed COPD patients. In these COPD patients, older age, female sex, low household income, and low BMI increased the risk for osteoporosis.

Keyword

Bone density; Osteoporosis; Pulmonary disease chronic obstructive; Quality of life

MeSH Terms

Absorptiometry, Photon
Body Mass Index
Bone Density
Education
Family Characteristics
Female
Femur
Femur Neck
Humans
Korea*
Male
Multivariate Analysis
Nutrition Surveys*
Osteoporosis*
Prevalence*
Pulmonary Disease, Chronic Obstructive*
Quality of Life*
Risk Factors
Smoke
Smoking
Spine
Smoke

Figure

• 

  Fig. 1 Flow chart of the study population. COPD, chronic obstructive pulmonary disease; BMD, body mineral density.

• 

  Fig. 2 Prevalence of osteoporosis according to the severity of chronic obstructive pulmonary disease. Stage I: forced expiratory volume in 1 second (FEV1)≥80%, stage II: FEV1=50–80%, stage III: FEV1=30–50%, stage IV: FEV1<30% (P=0.860).

Reference

1. Lehouck A, Boonen S, Decramer M, et al. COPD, bone metabolism, and osteoporosis. Chest. 2011; 139:648–657.

2. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001; 285:785–795.

3. Haentjens P, Magaziner J, Colón-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010; 152:380–390.

4. Inoue D, Watanabe R, Okazaki R. COPD and osteoporosis: links, risks, and treatment challenges. Int J Chron Obstruct Pulmon Dis. 2016; 11:637–648.

5. Bolton CE, Ionescu AA, Shiels KM, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004; 170:1286–1293.

6. Ferguson GT, Calverley PMA, Anderson JA, et al. Prevalence and progression of osteoporosis in patients with COPD: results from the TOwards a Revolution in COPD Health study. Chest. 2009; 136:1456–1465.

7. Sin DD, Man JP, Man SF. The risk of osteoporosis in Caucasian men and women with obstructive airways disease. Am J Med. 2003; 114:10–14.

8. Putcha N, Drummond MB, Wise RA, et al. Comorbidities and chronic obstructive pulmonary disease: prevalence, influence on outcomes, and management. Semin Respir Crit Care Med. 2015; 36:575–591.

9. Wen CP, Levy DT, Cheng TY, et al. Smoking behaviour in Taiwan, 2001. Tob Control. 2005; 14:Suppl 1. i51–i55.

10. Ministry of Health & Welfare. Korea Centers for Disease Control & Prevention. Korea health statistics 2010-2012: Korea national health and nutrition examination survey (KNHANES V) 2010-2012. Seoul: Ministry of Health & Welfare;2011.

11. Global Initiative for Chronic Obstructive Lung Disease. The global strategy for the diagnosis, management and prevention of COPD. 2017. cited by 2017 October 1. Available from: http://goldcopd.org.

12. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005; 26:319–338.

13. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994; 843:1–129.

14. Pickard AS, Wilke C, Jung E, et al. Use of a preference-based measure of health (EQ-5D) in COPD and asthma. Respir Med. 2008; 102:519–536.

15. Lee YK, Nam HS, Chuang LH, et al. South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states. Value Health. 2009; 12:1187–1193.

16. Franco CB, Paz-Filho G, Gomes PE, et al. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int. 2009; 20:1881–1887.

17. Jeon YK, Shin MJ, Kim WJ, et al. The relationship between pulmonary function and bone mineral density in healthy nonsmoking women: the Korean National Health and Nutrition Examination Survey (KNHANES) 2010. Osteoporos Int. 2014; 25:1571–1576.

18. Park EJ, Joo IW, Jang MJ, et al. Prevalence of osteoporosis in the Korean population based on Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011. Yonsei Med J. 2014; 55:1049–1057.

19. Watanabe R, Tanaka T, Aita K, et al. Osteoporosis is highly prevalent in Japanese males with chronic obstructive pulmonary disease and is associated with deteriorated pulmonary function. J Bone Miner Metab. 2015; 33:392–400.

20. Vrieze A, de Greef MH, Wijkstra PJ, et al. Low bone mineral density in COPD patients related to worse lung function, low weight and decreased fat-free mass. Osteoporos Int. 2007; 18:1197–1202.

21. Kjensli A, Falch JA, Ryg M, et al. High prevalence of vertebral deformities in COPD patients: relationship to disease severity. Eur Respir J. 2009; 33:1018–1024.

22. Gan WQ, Man SF, Senthilselvan A, et al. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax. 2004; 59:574–580.

23. Pitta F, Troosters T, Spruit MA, et al. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005; 171:972–977.

24. Lee JH, Hong AR, Kim JH, et al. Amount of smoking, pulmonary function, and bone mineral density in middle-aged Korean men: KNHANES 2008-2011. J Bone Miner Metab. 2017; DOI: 10.1007/s00774-017-0811-1.

25. Vestbo J, Prescott E, Almdal T, et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med. 2006; 173:79–83.

26. Graat-Verboom L, Spruit MA, van den Borne BE, et al. Correlates of osteoporosis in chronic obstructive pulmonary disease: an underestimated systemic component. Respir Med. 2009; 103:1143–1151.

27. Reid IR. Relationships between fat and bone. Osteoporos Int. 2008; 19:595–606.

28. Remels AH, Gosker HR, Langen RC, et al. The mechanisms of cachexia underlying muscle dysfunction in COPD. J Appl Physiol (1985). 2013; 114:1253–1262.

29. Menn P, Weber N, Holle R. Health-related quality of life in patients with severe COPD hospitalized for exacerbations - comparing EQ-5D, SF-12 and SGRQ. Health Qual Life Outcomes. 2010; 8:39.

30. Rutten-van Mölken MP, Oostenbrink JB, Tashkin DP, et al. Does quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages? Chest. 2006; 130:1117–1128.

31. Kwon HY, Ha YC, Yoo JI. Health-related quality of life in accordance with fracture history and comorbidities in Korean patients with osteoporosis. J Bone Metab. 2016; 23:199–206.

32. Jung HJ, Park YS, Seo HY, et al. Quality of life in patients with osteoporotic vertebral compression fractures. J Bone Metab. 2017; 24:187–196.

33. Sundh J, Johansson G, Larsson K, et al. Comorbidity and health-related quality of life in patients with severe chronic obstructive pulmonary disease attending Swedish secondary care units. Int J Chron Obstruct Pulmon Dis. 2015; 10:173–183.

34. Papaioannou A, Parkinson W, Ferko N, et al. Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada. Osteoporos Int. 2003; 14:913–917.