Hospital admissions and mortality in patients with COPD exacerbations and vertebral body compression fractures

Abstract

BackgroundVertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known.ObjectiveTo assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF.MethodsClinical characteristics and quality care indicators were assessed in two one-year periods, one retrospective (exploratory) and one prospective (validation), in all consecutive patients hospitalized for ECOPD. Diagnosis of VCF was based on the reduction of >20% height of the vertebral body evaluated in standard lateral chest X-ray (three independent observers).ResultsFrom the 248 patients admitted during the exploratory phase, a third had at least one VCF. Underdiagnosis rate was 97.6%, and patients with VCF had more admissions (normalized for survival), longer hospital stays, and higher mortality than patients without (4 [25th–75th percentiles, 2–8] vs 3 [1–6] admissions, P<0.01; 12 [6–30] vs 9 [6–18] days, P<0.05; and 50 vs 32.1% deaths, P<0.01, respectively). The risk of dying in the two following years was also higher in VCF patients (odds ratio: 2.11 [1.2–3.6], P<0.01). The validation cohort consisted of 250 patients who showed very similar results. The logistic regression analysis indicated that both VCF and age were factors independently associated with mortality.ConclusionAlthough VCF is frequently underdiagnosed in patients hospitalized for ECOPD, it is strongly associated with a worse prognosis and quality care outcomes.

Quantitative Vertebral Bone Density Seen on Chest CT in Chronic Obstructive Pulmonary Disease Patients: Association with Mortality in the Korean Obstructive Lung Disease Cohort

“…Moreover, osteoporosis leads to a greater risk of bone fractures, including hip and vertebral fractures; therefore, osteoporosis may affect mortality in the COPD population. Vertebral compression fractures, with osteoporosis being the leading cause, have been significantly associated with mortality in patients with COPD exacerbation (8). In our study, we attempted to assess the association between DThorax and mortality in patients with COPD; lower DThorax was a significant predictor of mortality in the patients with COPD.…”

“…Patients with osteoporosis are at a higher risk of bone fractures that may result in increased morbidity and mortality. The rib fractures or vertebral compression fractures and the resultant kyphosis have been reported to reduce pulmonary function in COPD patients and could contribute to patients' mortality in those with COPD exacerbation (6)(7)(8). The current gold standard for diagnosing osteoporosis is dual-energy X-ray absorptiometry (DXA) and DXA of the lumbar spine and hip is currently the most commonly used reference standard (9,10).…”

Back Pain-Inducing Test, a Novel and Sensitive Screening Test for Painful Osteoporotic Vertebral Fractures: A Prospective Clinical Study

“…Second, the study was conducted strictly according to the standards for reporting diagnostic accuracy (STARD). Third, the validity of the BPIT was both qualitatively and quantitatively assessed, and the latter is a gold standard for a self‐reported pain assessment tool . Fourth, VFs were diagnosed based on whole‐spine MRI with T1WI, T2WI, and STIR images, which is the gold standard for fresh or unhealed VFs .…”

“…Third, the validity of the BPIT was both qualitatively and quantitatively assessed, and the latter is a gold standard for a self-reported pain assessment tool. (34)(35)(36)(37) Fourth, VFs were diagnosed based on whole-spine MRI with T1WI, T2WI, and STIR images, which is the gold standard for fresh or unhealed VFs. (8,(21)(22)(23)25) Moreover, the accuracy of the final diagnosis was guaranteed with support from an excellent interrater consistency among surgeons for MRI interpretation.…”

<p>COPD and Osteoporosis: Associated Factors in Patients Treated with Inhaled Corticosteroids</p>

“…3 Osteoporotic fractures are associated with decreased quality of life and increased mortality in patients with COPD. 4,5 Although osteoporosis is a well-known complication of COPD it is usually underestimated and undertreated. 6 Mechanisms by which osteoporosis occurs in COPD patients are mostly unknown.…”