Title : Chronic Obstructive Pulmonary Disease (COPD) in patients with hip fractures: prevalence, clinical characteristics, and impact on outcomes
Background: There is a paucity of information regarding patients with COPD and hip fracture (HF), one of the most devastating diseases in the elderly.
Objective: To explore in a large cohort of HF patients the prevalence of COPD, its clinical profile and impact on hospital outcomes.
Methods: In 3681 consecutive patients (mean age 82.8±8.26 years, 74.8% females) admitted with a HF between 1999 – 2018 data on comorbidities, laboratory parameters, including bone turnover markers, medications, and in-hospital outcomes (mortality, length of stay) have been analysed. The prevalence of COPD (adjusted for age and gender) among HF patients and in the general population (data from Australian Bureau of Statistics and Australian Institute of Health and Welfare) were compared.
Results: The prevalence of COPD among HF patients was 15.3% (n=563; 13.8% among females and 19.7% among males), while in the total Australian population aged 65 years and above it was about 7.5% in males and 6.7% in females. The group of HF patients with COPD compared to the rest of the cohort had a higher proportion of subjects younger than 80 years of age (35,2% vs. 29.5%, p=0.008), males (32.5% vs. 23.9%, p<0.001), current (13.3% vs. 3.9%, p<0.001) and ex-smokers (23.3% vs.10.3%, p<0.001), alcohol over-users (7.8% vs. 3.7%, p<0.005), walking aids users (39.1% vs. 34.5%, p=0.039), with a history of coronary artery disease (CAD, 36.8% vs. 25.6%, p<0.001), myocardial infarction (MI,10.3% vs.7.3%, p=0.016), and elevated PTH levels (>6.8 pmol/L: 52.6% vs. 48.0%, p=0.51). The COPD group did not differ from the non-COPD patients in regard the mean age, but the males were younger (on average 1.6 years, p=0.020). The percentage of patients admitted from a permanent residential care facility, diagnosed with hypertension, atrial fibrillation, stroke, chronic kidney disease, anaemia, type 2 diabetes mellitus, dementia and Parkinson’s disease as well as with hypoalbuminemia (<33g/L), vitamin D deficiency [25(OH)D<25 nmol/L] or insufficiency [25(OH)D<50 nmol/L] was similar in groups with and without COPD; the bone turnover markers (P1NP and βCTX) also did not show significant difference. The COPD patients were more often prescribed anti-resorptive drugs (mainly bisphosphonates, 17.4% vs.11.3%, p<0.001) and vitamin D supplements (33.0% vs. 28.6%, p=0.035) but not calcium supplements (15.4% vs.17.3%, p=0.301). The COPD group had a 1.6-fold higher mortality rate (7.6% vs. 4.7%, p=0.007) and a significantly increased number of patients with prolonged hospital stay above 10 days (66.1% vs. 60.7%, p=0.016) or 20 days (29.8% vs. 24.6%, p=0.010).
Conclusions: The prevalence of COPD among HF patients is about 2-fold higher than in the general population of the same age and gender. Patients with COPD comprise 15.3% of the total HF cohort. This group demonstrates a higher proportion of males, users of walking aids, smokers, alcohol over-users, individuals with a history of CAD, MI and hyperparathyroidism, but only one of six patients received osteoporotic therapy pre-HF. Presence of COPD in HF patients is associated with poor outcomes, namely, in-hospital death and prolonged hospitalisation. Assessment of bone status and preventive osteoporotic treatment should be implemented in routine clinical practice for all COPD patients.