Screening, prevention and treatment of osteoporosis in patients with chronic obstructive pulmonary disease - a population-based database study

Introduction: A common extrapulmonary effect to chronic obstructive pulmonary disease (COPD) is osteoporosis. Objectives: To characterise the diagnostic activity regarding osteoporosis [i.e. the use of dual-energy X-ray absorptiometry (DXA)] and the pattern of applied pharmacological intervention to prevent fractures in COPD patients in relation to the use of prednisolone. Methods: This study was a register study covering the residents of the Danish County of Funen linking data from Odense Pharmacoepidemiologic Database (OPED), a DXA-database and Funen Patient Administrative System, a database with data on hospitals admissions. OPED has complete capture of fulfilled prescriptions. We identified 1909 COPD patients admitted with a main diagnosis of COPD. Using OPED we extracted prescriptions for prednisolone and antiresorptive medicine from these COPD patients for the year 2004. Results: COPD patients who had filled a prescription for prednisolone (P-COPD) were DXA-scanned more frequently (17%) than those who had not (non-P-COPD) (9%) and were prescribed antiresorptive medicine more often (27%) than non-P-COPD (16%). In both groups 94% were either osteopenic or osteoporotic. Logistic regression models predicted that DXA-scans were offered to women, to the young, to the recipients of high systemic steroid doses and to those with frequent admission for COPD. Given an osteoporosis diagnosis, treatment was offered to those with high steroid doses and those with frequent admissions for COPD. Conclusion: DXA are underutilised compared with the high frequency of osteoporosis or osteopenia in DXA-scanned hospitalised COPD patients, especially in elderly. Guidelines concerning screening, prevention and treatment of osteoporosis in COPD patients with or without glucocorticoid treatment are needed. Please cite this paper as: Madsen H, Brixen K and Hallas J. Screening, prevention and treatment of osteoporosis in patients with chronic obstructive pulmonary disease - a population-based database study. The Clinical Respiratory Journal 2009; DOI:10.1111/j.1752-699X.2009.00138.x.