<p>Management of Fracture Risk in Patients with Chronic Obstructive Pulmonary Disease (COPD): Building a UK Consensus Through Healthcare Professional and Patient Engagement</p>

Abstract

Introduction: Osteoporosis and bone fractures are common in chronic obstructive pulmonary disease (COPD) and contribute significantly to morbidity and mortality. Current national guidance on COPD management recommends addressing bone health in patients, however, does not detail how. This consensus outlines key elements of a structured approach to managing bone health and fracture risk in patients with COPD. Methods: A systematic approach incorporating multifaceted methodologies included detailed patient and healthcare professional (HCP) surveys followed by a roundtable meeting to reach a consensus on what a pathway would look like. Results: The surveys revealed that fracture risk was not always assessed despite being recognised as an important aspect of COPD management by HCPs. The majority of the patients also stated they would be receptive to discussing treatment options if found to be at risk of osteoporotic fractures. Limited time and resource allocation were identified as barriers to addressing bone health during consultations. The consensus from the roundtable meeting was that a proactive systematic approach to assessing bone health should be adopted. This should involve using fracture risk assessment tools to identify individuals at risk, investigating secondary causes of osteoporosis if a diagnosis is made and reinforcing non-pharmacological and preventative measures such as smoking cessation, keeping active and pharmacological management of osteoporosis and medicines management of corticosteroid use. Practically, prioritising patients with important additional risk factors, such as previous fragility fractures, older age and long-term oral corticosteroid use for an assessment, was felt required. Conclusion: There is a need for integrating fracture risk assessment into the COPD pathway. Developing a systematic and holistic approach to addressing bone health is key to achieving this. In tandem, opportunities to disseminate the information and educational resources are also required.

Incidence of osteoporosis and ambient air pollution in South Korea: a population-based retrospective cohort study

“…Peptic ulcer disease is an independent risk factor for osteoporosis regardless of calcium intake [ 29 ]. Additionally, chronic diseases including cardiovascular disease [ 30 ], diabetes mellitus [ 31 ], liver disease [ 32 ], musculoskeletal deformity [ 33 ], depression [ 34 ], and pulmonary disease [ 35 ], which had been diagnosed before osteoporosis and had similar mechanisms, were controlled. Therefore, PM 10 can be understood as an independent risk factor for osteoporosis, although this study did not measure directly patient lifestyle or bodyweight.…”

Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review

“…In addition, even though PR inpatients’ intensive services might guarantee effective PR programs in both acute and subacute patients, the outpatient referral and community settings might not be effective in the management of chronic COPD patients [ 71 , 74 ]. Beyond PR programs, osteoporosis management is historically underrecognized and underestimated in these patients despite the social and economic burden of fragility fractures [ 75 ]. In this scenario, it has been proposed that a close networking between hospital and community settings might improve the long-term management of frail patients with COPD [ 5 ].…”