Aims: Multimorbidity is common among chronic obstructive pulmonary disease (COPD) patients and osteoporosis is a significant complication which is often undiagnosed until fracture occurs1-2. Bone mineral density and fracture risk assessment tools includes 4 comorbid and lifestyle characteristics, therefore do not reflect multimorbidity, seen in COPD patients3-8. Femoral bone cortical thickness (FBCT) is a new tool to assess skeletal status9. This study aims to assess the effect of comorbidities on FBCT in hip fracture (HF) patients with COPD.
Methods: FBCT was measured in 426 HF patients (mean age 80.5 years) and 106 healthy controls (mean age 32.0 years) at 3 cm and 10 cm. Data were correlated with 19 comorbid and lifestyle characteristics and bone turnover markers.
Results: In HF patients, FBCT was significantly lower than controls (all p <0.005) at both levels. Low FBCT was found in 79% of males and 67% of females with COPD and HF. The proportion of patients with low FBCT increased in parallel with the number of comorbidities; in males: 7.7% (no comorbidities) to 44.3% (with ≥3 comorbidities) and in females: 3.7% to 36.3%, respectively. The lowest FBCT demonstrated in males with stroke (85.7%), walking aids users (81.3%) and anaemia (80.0%); in females, transient ischaemic attack (86.4%), stroke (77.1%) and excessive alcohol used (77.8%). Bone turnover markers have significantly, however weakly associated with FBCT.
Conclusions: This study highlights the impact of comorbidities on FBCT in HF patients with COPD, underscoring the importance of routine osteoporosis screening in COPD patients, particularly those with multiple comorbidities.