Risk factors and prognostic value of osteoporosis in hospitalized patients with bronchiectasis

Abstract

Background The risk factors for osteoporosis and its prognostic value in patients with bronchiectasis is not well characterized. We explored the risk factors for osteoporosis and its prognostic impact in hospitalized non-cystic fibrosis bronchiectasis (NCFB) patients in Southeast China. Methods This observational cohort study consecutively enrolled 179 hospitalized patients with NCFB bronchiectasis between 2017 and 2021. The risk factors and the impact of osteoporosis on all-cause mortality were assessed. Results 21.2% (38/179) of hospitalized NCFB patients were diagnosed with osteoporosis. Patients with osteoporosis had more severe symptoms (assessed by chronic airway assessment test, CAT, median 22 vs. 17, P = 0.017), poorer quality of life (assessed by St. George Respiratory Questionnaires, SQRC, median 42 vs. 27, P = 0.007), more severe disease stage (assessed by bronchiectasis severity index, BSI, median 14 vs. 11, P = 0.02), more comorbidities (assessed by Bronchiectasis Aetiology Comorbidity Index, BACI, median 5 vs. 4, P = 0.021) than patients without. Age, female sex, anemia, post-infection, and history of regular inhaled corticosteroid treatment were independent risk factors for osteoporosis in those patients. 21 patients (11.7%) died over a median follow-up period of 32 months. The all-cause mortality in NCFB patients with osteoporosis [28.94% (11/38)] was significantly higher than those without osteoporosis [7.09% (10/141)] [hazard ratio (HR) 5.34, 95% confidence interval (CI) 2.26–12.67, P < 0.001]. After adjusting for BSI and other confounding factors, osteoporosis was still independently associated with all-cause mortality in hospitalized NCFB patients (HR 4.29, 95% CI 1.75–10.49, P < 0.001). Conclusions Osteoporosis had an independent effect on all-cause mortality in hospitalized NCFB patients. Management of comorbidities, including bone health, is a critical aspect of treating NCFB patients.

Nontuberculous Mycobacteria, Mucociliary Clearance, and Bronchiectasis

“…Additional disorders of the skeletal system, which includes bone and connective tissue, are also produced by mutations in primary cilia genes [84] and are frequently associated with respiratory infections and bronchiectasis. Osteoporosis, which may appear when ciliary genes, such as IFT80, IFT88, or Kif3a, are mutated [84], is considered a risk factor for bronchiectasis [85,86]. Asphyxiating thoracic dystrophy (Jeune's syndrome) may be caused by mutations in ciliary genes such as DYNC2H1 [75], and mutations in DYNC2H1 [87] and in KIAA0753 [88] were present in patients with recurrent respiratory infections.…”

Aspergillus and Aspergillosis in People with Chronic Diseases

“…There is little data on how Aspergillus infections affect osteoporosis, but some studies have found a link between osteoporosis and persistent Aspergillus lung infections. This is due to the possibility of persistent inflammation brought on by Aspergillus infections, which can promote bone resorption and reduce bone growth [71]. Additionally, corticosteroids and other antifungal drugs used to treat Aspergillus infections can raise the risk of osteoporosis.…”