Loss of muscle and bone mass with increased adiposity and fractures in patients with chronic obstructive pulmonary disease: A 5-year follow-up cohort study

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Musculoskeletal fragility in Chronic obstructive pulmonary disease (COPD) is often overlooked. Using an observational cohort of COPD patients followed over five years, a higher fracture rate was observed alongside significant loss of bone and muscle mass, as well as increased fat mass index. Chronic obstructive pulmonary disease (COPD) is associated with a higher risk of sarcopenia and fractures. We aim to assess changes in body composition and bone mineral density (BMD), and the occurrence of fractures in patients with COPD from a tertiary hospital. Forty patients with COPD (mean age 69.0 ± 7.5 years; 21 women) who joined the cohort at baseline (November 2013 to December 2015) were reevaluated after a median follow-up of 58 months (final assessment). BMD, appendicular lean mass (ALM), body fat (BF), and fat mass index (FMI) were measured using DXA, along with spine radiography with vertebral morphometry at both assessments. There was a significant increase in the rates of vertebral (22.5% versus 38.5%; P = 0.031) and non-vertebral (12.5% versus 17.5%; P < 0.001) fractures. Half of the fractures occurred in patients with a BMD T-score > -2.5. Notable decreases were observed in ALM (17.5 ± 4.0 versus 16.5 ± 4.1 kg/m 2 ; P < 0.001) and total femur BMD (0.901 ± 0.144 versus 0.862 ± 0.136 g/cm 2 ; P < 0.001), along with an increase in FMI (8.5 ± 5.4 versus 11.8 ± 5.8 g/cm 2 ; P < 0.001). Serum 25-hydroxyvitamin D < 30 ng/mL and baseline lumbar spine BMD were significant predictors of fat mass loss (OR = 8.33, 95% CI 1.16–59.93; P = 0.035) and bone loss at the spine (OR = 1.05, 95% CI 1.01–1.10; P = 0.037), respectively. Higher airflow obstruction was a significant predictor for the combined outcome of bone loss and incident fracture (OR = 22.04, 95% CI 1.17–416.52; P = 0.039). Over a 5-year follow-up, COPD patients experience a significant loss of BMD and lean mass, along with increased adiposity and fractures.

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