Chronic Obstructive Pulmonary Disease versus Type 2 Diabetes Mellitus: A Comparative and Additive Risk Assessment of...

Chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM) are both associated with bone fragility through distinct mechanisms. COPD is characterized by accelerated bone resorption, whereas T2DM is associated with impaired bone quality despite preserved bone mineral density.

Does COPD confer greater skeletal hazards than T2DM, and does concomitant COPD and T2DM further increase the risks of osteoporosis and fractures?

We conducted a nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database. Propensity score matching was applied to construct three comparison cohorts of patients with T2DM, COPD, and concomitant COPD and T2DM. Adjusted hazard ratios (aHRs) for incident osteoporosis, major osteoporotic fractures (MOF), and site-specific fractures were estimated using multivariable Cox proportional hazards models after adjustment for demographic characteristics, comorbidities, and medication use.

Compared with T2DM, COPD was associated with a significantly higher hazard of osteoporosis (aHR, 1.51; 95% CI, 1.35-1.69). Patients with concomitant COPD and T2DM also had higher hazards of osteoporosis (aHR, 1.39; 95% CI, 1.23-1.57), MOF (aHR, 1.19; 95% CI, 1.08-1.32), spine fractures (aHR, 1.35; 95% CI, 1.16-1.58), and radioulnar fractures (aHR, 1.21; 95% CI, 1.02-1.43) than patients with T2DM alone. In contrast, osteoporosis and fracture risks were comparable between patients with concomitant COPD and T2DM and those with COPD alone. Subgroup analyses identified significant effect modification by sex, with the association between COPD and osteoporosis being stronger in men than in women.

COPD is significantly more toxic to the skeleton than T2DM, and their coexistence amplifies fracture susceptibility compared to T2DM alone. Importantly, male patients with COPD represent a distinctly vulnerable population, exhibiting a pronounced susceptibility to disease-induced bone loss. Clinicians must prioritize early and targeted osteoporosis screening for COPD patients, especially men.