The silent fractures: unmasking osteoporosis in south Indian chronic obstructive pulmonary disease patients

Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder characterized by persistent airflow limitation and chronic respiratory symptoms. COPD is the second leading cause of death in India and the third leading cause of death worldwide. Osteoporosis, a significant and often overlooked comorbidity of COPD, presents a major challenge. The disease itself, combined with multiple risk factors, including the use of inhaled corticosteroids—a cornerstone of COPD treatment—contributes to a decline in bone mineral density (BMD). This cross-sectional study investigates the prevalence of osteopenia and osteoporosis among COPD patients at a tertiary care center in South India, with a particular focus on the impact of inhaled and systemic corticosteroids on BMD and other associated risk factors. One hundred COPD patients were assessed for their BMD. Our findings reveal a strikingly high prevalence (88%) of reduced BMD among COPD patients, with 69% diagnosed with osteoporosis and 19% with osteopenia. Most COPD patients are middle-aged smokers and frequently use steroid-containing inhalers, which contribute to decreased BMD and an increased risk of fractures. The study highlights a significant association between osteoporosis and factors such as smoking history, COPD severity (GOLD classification), and cumulative steroid exposure. These results highlight the urgent need for proactive, regular screening and early intervention to assess bone health in COPD care.