The Association Between Chronic Obstructive Pulmonary Disease and the Risks of Falls and Osteoporosis: A Cohort Study in the UK Biobank

Abstract

Objective To explore the associations of chronic obstructive pulmonary disease (COPD) with falls and osteoporosis, and the potential modifications of the associations. Methods We included 47,4669 participants without prior falls or osteoporosis from the UK Biobank. COPD at baseline was defined using a combination of self-reported information and hospitalization records with ICD-9 code of 496 or ICD-10 code of J40–J44, while the fall and osteoporosis were ascertained by ICD-10 until the day (April 6th, 2021). Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of COPD with falls and osteoporosis. Additionally, subgroup and interaction analyses were performed to explore potential effect modifiers. Results Among the included participants, 45.8% were males and the mean age was 56.4 years. A total of 22,363 (4.7%) participants had COPD. During a median follow-up of 12.1 years, 28,527 participants experienced falls and 8811 were diagnosed with osteoporosis. After adjustment for demographic characteristics, lifestyle factors, and comorbidities, COPD was associated with higher risks of falls (HR 1.51, 95% CI 1.45 to 1.58) and osteoporosis (HR 2.37, 95% CI 2.22 to 2.53). A significant interaction with sex was observed for osteoporosis (HR 2.94, 95% CI 2.54 to 3.40 in males and HR 2.25, 95% CI 2.09 to 2.42 in females, P for interaction<0.001). Smoking status significantly modified the association with falls, with HRs of 1.37 (95% CI 1.28 to 1.47) in never smokers, 1.54 (95% CI 1.44 to 1.64) in previous smokers, and 1.77 (95% CI 1.61 to 1.95) in current smokers (P for interaction<0.001). Conclusion COPD was associated with the increased risks of falls and osteoporosis. These associations may be modified by sex and smoking status.