Introduction Whilst osteoporosis is associated with COPD, little is known on its prevalence in non-cystic fibrosis bronchiectasis (NCFBr). We assessed the impact of factors associated with NCFBr disease severity on bone mineral density (BMD) and DEXA referral patterns in NCFBr.
Methods BMD reports from DEXA scanners were collected for all NCFBr patients from our specialist clinic database and T-scores for lumbar spine (LS), total left hip (TLH) and neck of femur (NOF) were recorded. Osteoporosis was defined as T-scores ≤–2.5, osteopenia between –1 and –2.5 and normal BMD ≥–1. FEV1 values, exacerbation frequency and Pseudomonas aeruginosa chronic infection (defined as >1 positive sputum result in past 12 months) were recorded.
Results 336 NCFBr patients were identified attending the specialist clinic. 101 patients had DEXA scans performed (30%); 96 reports were retrievable. The male:female ratio was significantly different between scanned patients (29%:71%) and the entire NCFBr patient cohort (41%:59%): p<0.01 (two-tailed chi-squared test). Osteoporosis was detected in the same percentage of scanned males as females (32%, any site). The prevalence of osteoporosis identified was similar across different scan sites (see table). Mean FEV1 (% predicted) for DEXA-scanned patients was 58.2 (±28.4), 24% were colonised with P. aeruginosa and mean number of exacerbations was 4.7/year (±3.0; n=44). No significant correlation was found between T-scores (any site) and FEV1% pred values, P. aeruginosa colonisation or number of exacerbations.
Conclusion More than 40% of NCFBr patients have osteopenia and more than 25% have osteoporosis; this is higher than seen in COPD (e.g. NHANES, Schnell et al, 2012). Male patients had lower DEXA scanning rates suggesting referral bias favouring females. Low BMD is not predictable based on NCFBr “disease severity parameters”. Greater emphasis on investigating NCFBr patients for osteoporosis, particularly males, may improve the incidence rate of fragility fractures in this patient population. Future studies on steroid use and osteoporosis incidence rates in this population would also be beneficial.
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