Underutilization of Osteoporosis Screening in Patients With Severe COPD and Long Term Corticosteroid Use

Chronic obstructive pulmonary disease (COPD) is increasing in prevalence in our aging population in the United States, contributing to morbidity and mortality. Chronic obstructive pulmonary disease and osteoporosis have significant overlapping pathogenic risk factors, including smoke exposure, a chronic inflammatory state, poor nutritional status, immobility, and chronic steroid exposure. This study determines the use of DEXA screening, the prevalence of fragility fractures, and prescription and the use of antiresorptive medications for treatment of osteoporosis and osteopenia in patients with COPD.

A retrospective chart review of patients at our health sciences center, including both clinics and hospital, was performed based on ICD-10 codes for COPD, chronic steroid use, and chronic oxygen support in the Cerner database from 2019 to 2023. Exclusion criteria included preexisting or alternative primary lung disease and/or cancer or if further chart review excluded them for not having severe COPD (FEV1 <50%) or not requiring oxygen therapy.

One hundred seventy-one patients of the original 203 enrolled patients qualified for further analysis after thorough review of charts for confounding diagnosis, lack of oxygen therapy, or lack of formal COPD diagnosis. Forty-one (24%) were screened for osteopenia/osteoporosis using DEXA screening. Of those, 18 (43%) had osteopenia, and 18 (43%) had osteoporosis. Of the 171 eligible patients enrolled in the analysis, 59 (35%) had a fragility fracture. Patients on both inhaled and oral systemic steroids had the highest fracture rate (39%). Overall, 14% (24/171) of patients received treatment for osteopenia/osteoporosis using antiresorptive medications. Treatment rates varied among those receiving steroids versus those who did not. Of the screened group, only 8/18 (44%) patients with osteopenia and 7/18 (39%) patients with osteoporosis received treatment.

This study demonstrates the patients with severe COPD, based on oxygen requirements and/or the use of corticosteroids, do not have adequate screening for osteopenia and/or osteoporosis. This screening could lead to antiresorptive drug treatment and reduce the morbidity and mortality associated with osteoporotic and osteopenia fractures.