The impact of osteoporosis and vertebral compression fractures on mortality and association with pulmonary function in COPD: A meta-analysis

Objective: Osteoporosis is highly prevalent among patients with chronic obstructive pulmonary disease (COPD) and most commonly presents as a vertebral compression fracture (VCF). Our objective was to quantify the effect of osteoporosis and VCFs on the mortality and pulmonary function tests (PFTs), such as forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC), of patients with COPD.

Methods: A PubMed/Medline search was conducted using the search terms "chronic obstructive pulmonary disease", "osteoporosis" and "vertebral compression fracture". Meta-analyses were conducted to evaluate the differences in mortality and PFTs between patients with COPD with and without osteoporosis or VCFs, according to PRISMA guidelines. PROSPERO registration: CRD42019120335.

Results: Of the 896 abstracts identified, 27 studies describing 7662 patients with COPD of which 1883 (24.6%) had osteoporosis or VCFs, were included. Random effects model analysis demonstrated that patients with COPD and osteoporosis or VCFs had an increased OR for mortality of 2.40 (95% CI: 1.24; 4.64, I²=89%, P<0.01), decreased FEV₁/FVC with a mean difference of -4.80% (95% CI: -6.69; -2.90, I²=83%, P<0.01) and decreased FEV₁, with a mean difference of -4.91% (95% CI: -6.51; -3.31, I²=95%, P<0.01) and -0.41 L (95% CI: -0.59; -0.24, I²=97%, P<0.01), compared to control subjects. Apart from FEV₁ (liters) in subgroup 1 (P=0.06), all subgroup analyses found significant differences between groups, as did sensitivity analysis of low risk of bias studies.

Conclusion: Osteoporosis and VCFs are associated with a significant reduction in survival and pulmonary function among patients with COPD.