Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
College of Pharmacy, Chung-Ang University, Seoul, Korea.
Korean J Intern Med. 2022 May;37(3):631-638. doi: 10.3904/kjim.2021.152. Epub 2022 Feb 8.
BACKGROUND/AIMS: Hip fracture and acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) could increase mortality in patients with COPD. There are no data on the relationship between AE-COPD and hip fracture, which may significantly affect the prognosis of patients with COPD. Therefore, we conducted this study to determine the effects of AE-COPD on hip fractures in patients with COPD.
This retrospective, nested, case-control study included 253,471 patients with COPD (≥ 40 years of age) identified from the Korea National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) from 2002 to 2015. Among 176,598 patients with COPD, 1,415 patients with hip fractures were identified. Each case was matched to one control for age (within 10 years), sex, and year of COPD diagnosis. We estimated the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for hip fractures associated with AE-COPD using conditional logistic regression analysis, adjusting for underlying diseases and smoking history.
In patients with AE-COPD, the risk of hip fracture was 2.50 times higher, regardless of systemic corticosteroid use and underlying disease (aOR, 2.50; 95% CI, 1.67 to 3.75). The risk of hip fracture increased if there was one episode of AE in the year before hip fractures (aOR, 2.25; 95% CI, 1.66 to 3.05). Moreover, the risk of hip fracture also increased in patients with more than two episodes of AE the year before hip fractures (aOR, 2.57; 95% CI, 1.61 to 4.10).
AE-COPD increases the risk of hip fracture regardless of underlying diseases, including osteoporosis, and treatment with systemic corticosteroids.
背景/目的：髋部骨折和慢性阻塞性肺疾病（COPD）急性加重（AE-COPD）可增加 COPD 患者的死亡率。目前尚无 AE-COPD 与髋部骨折之间关系的相关数据，而这可能会显著影响 COPD 患者的预后。因此，我们开展了这项研究，以确定 AE-COPD 对 COPD 患者髋部骨折的影响。
这是一项回顾性、巢式病例对照研究，纳入了 2002 年至 2015 年期间从韩国国家健康保险服务-国家健康筛查队列（NHIS-HEALS）中筛选出的 253471 例年龄≥40 岁的 COPD 患者。在 176598 例 COPD 患者中，共确定了 1415 例髋部骨折患者。将每位病例与一名年龄（相差不超过 10 年）、性别和 COPD 诊断年份匹配的对照相匹配。采用条件 logistic 回归分析，调整潜在疾病和吸烟史后，评估 AE-COPD 与髋部骨折之间的比值比（aOR）和 95%置信区间（CI）。
在患有 AE-COPD 的患者中，髋部骨折的风险增加了 2.50 倍，无论是否使用全身性皮质类固醇和潜在疾病（aOR，2.50；95%CI，1.67 至 3.75）。如果在髋部骨折前一年有一次 AE 发作，髋部骨折的风险增加（aOR，2.25；95%CI，1.66 至 3.05）。此外，如果在髋部骨折前一年发生超过两次 AE，髋部骨折的风险也会增加（aOR，2.57；95%CI，1.61 至 4.10）。
无论是否存在骨质疏松症等潜在疾病，以及是否使用全身性皮质类固醇治疗，AE-COPD 均会增加髋部骨折的风险。
