MONDAY, Aug. 31, 2020 (HealthDay News) — The addition of lung-specific risk factors into fracture risk assessment tools may more accurately predict hip fracture risk in smokers, according to a study published online Aug. 4 in the Journal of Bone and Mineral Research.

Jessica Bon, M.D., from the University of Pittsburgh, and colleagues assessed whether lung-specific factors are associated with incident hip fracture to improve risk discrimination of traditional fracture risk models in smokers. The analysis included 9,187 current and former smokers participating in the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease study, with 361 incident hip fractures.

The researchers found that lung-specific risk factors included the following: postbronchodilator percent forced expiratory volume in one second predicted (odds ratio [OR], 0.95 for each 10 percent increase); Global Initiative for Chronic Obstructive Lung Disease classification (OR, 1.09); presence of computed tomography (CT)-determined emphysema (OR, 1.34); symptom scores (OR, 1.10); six-minute walk distance (OR, 0.92 for each 30-m increase); body mass index, airflow obstruction, dyspnea, and exercise index (OR, 1.07); total exacerbations (OR, 1.13 per exacerbation); and annual exacerbations (OR, 1.37 per exacerbation). Age, Black race, osteoporosis, prevalent hip and spine fracture, rheumatoid arthritis, and diabetes were associated with incident hip fracture in multivariable modeling. Risk discrimination of traditional models was improved with the addition of the presence of emphysema, six-minute walk distance, and total number of exacerbations (relative integrated discrimination improvement of 12.8, 6.3, and 34.6 percent, respectively).

“We need to look beyond traditional risk factors when making osteoporosis screening and management decisions in our patients with chronic obstructive pulmonary disease (COPD),” Bon said in a statement. “A former smoker with frequent COPD exacerbations or significant emphysema on chest CT scan may be at greater risk of fracture than would be expected based on age or sex or other underlying comorbidities alone.”

Several authors disclosed financial ties to the pharmaceutical industry.

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