# Prevalence and Correlates of Osteoporosis and Metabolic Syndrome Among Patients With Chronic Obstructive Pulmonary Disease at a Rural Tertiary Healthcare Center in India

## TL;DR

This study finds that osteoporosis and metabolic syndrome are highly common in COPD patients in rural India and identifies factors like COPD severity and smoking that contribute to these conditions.

## Contribution

The study is the first in India to investigate the prevalence and correlates of both osteoporosis and metabolic syndrome among COPD patients.

## Key findings

- Osteoporosis prevalence was 70.25% and metabolic syndrome was 62.53% among COPD patients.
- Metabolic syndrome was significantly associated with osteoporosis and influenced by COPD severity, BMI, and smoking.
- Corticosteroid administration route and duration did not affect bone mineral density T-scores.

## Abstract

Background

Chronic obstructive pulmonary disease (COPD) results from chronic inflammation triggered by various risk factors. This inflammation can also impact other organ systems. COPD patients often have comorbidities such as osteoporosis and metabolic syndrome. Osteoporosis is a skeletal disorder characterized by reduced bone mineral density (BMD), while metabolic syndrome encompasses central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, hyperglycemia, and hypertension. The coexistence of both osteoporosis and metabolic syndrome in COPD patients has not been previously studied in India.

Aim and objectives

The aim of this study is to determine the prevalence of osteoporosis and metabolic syndrome, as well as their associated factors, among patients with COPD at a rural tertiary healthcare center in India.

Materials and methods

A total of 363 COPD patients were included in this study, comprising 153 males and 210 females. This hospital-based cross-sectional study was conducted at a rural tertiary healthcare center in India. The diagnosis of COPD and classification of airflow limitation severity were based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 guidelines. The WHO criteria for osteoporosis and osteopenia were used to diagnose osteoporosis in the study participants. BMD was measured using dual-energy X-ray absorptiometry (DEXA). Metabolic syndrome was diagnosed using the National Cholesterol Education Program: Adult Treatment Panel III criteria.

Results

The mean age of patients diagnosed with osteoporosis was 68.42 ± 11.38 years, while the mean age of those diagnosed with metabolic syndrome was 64.46 ± 10.37 years. Among the 363 study participants, the prevalence of osteoporosis was 70.25%, and the prevalence of metabolic syndrome was 62.53%. A significant association was found between the GOLD severity grading of COPD, BMI, education level, and socioeconomic status with the T-score of the DEXA scan. However, no significant association was observed between the duration and route of corticosteroid administration and the T-score categories of BMD. In contrast, metabolic syndrome was significantly associated with GOLD severity grading, BMI, education level, socioeconomic status, duration and route of corticosteroid administration, smoking status, and duration of biomass fuel exposure. Additionally, smoking status and biomass fuel exposure duration also showed a significant association with osteoporosis. Notably, metabolic syndrome itself was significantly associated with the presence of osteoporosis.

Conclusions

Both osteoporosis and metabolic syndrome are highly prevalent among COPD patients in the Indian population. Several factors significantly influence the occurrence of these conditions, including the severity of COPD, BMI, education level, socioeconomic status, smoking status, and duration of biomass fuel exposure. Furthermore, metabolic syndrome itself plays a crucial role in the development of osteoporosis in individuals with COPD.