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Chest. 2019 Jul 25. pii: S0012-3692(19)31379-0. doi: 10.1016/j.chest.2019.06.036. [Epub ahead of print]

Prevalence and Risk Factors for Osteoporosis in Individuals With COPD: A Systematic Review and Meta-analysis.

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Department of Sports Medicine, China Medical University, Taichung, Taiwan. Electronic address:
Department of Physical Therapy, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
Department of Radiology, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, VA Pittsburgh Healthcare System.
Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute; Interdivisional Department of Critical Care Medicine, Toronto, ON, Canada.



Osteoporosis is prevalent in individuals with COPD. Updated evidence is required to complement the previous systematic review on this topic to provide best practice. The aim of this systematic review and meta-analysis was to quantitatively synthesize data from studies with respect to the prevalence and risk factors for osteoporosis among individuals with COPD.


EMBASE, CINAHL, MEDLINE, and PubMed databases were searched for articles containing the key words "COPD," "osteoporosis," "prevalence," and "risk factor." Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine osteoporosis prevalence and risk factors in individuals with COPD. Meta-regression analyses were conducted to explore the sources of heterogeneity.


The pooled global prevalence from 58 studies was 38% (95% CI, 34-43). The presence of COPD increased the likelihood of having osteoporosis (OR, 2.83). Other significant risk factors for osteoporosis in COPD patients were BMI < 18.5 kg/m2 (OR, 4.26) and the presence of sarcopenia (OR, 3.65).


Osteoporosis is prevalent in individuals with COPD, and the prevalence seems to be high and similar in many countries. Patients with COPD should be screened for osteoporosis and contributing risk factors.


COPD; meta-analysis; osteoporosis; systematic review

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