Breaking Bad: The Shocking Gap in Osteoporosis Care for Chronic Obstructive Pulmonary Disease Patients

Abstract Background Chronic obstructive pulmonary disease (COPD) is closely linked to osteoporosis and fragility fractures due to factors like chronic inflammation, glucocorticoid use, and vitamin D deficiency. Despite NOGG guidelines, FRAX® assessments and bone-protective therapies are underutilized in this population. This study aims to evaluate bone health and identify treatment gaps in osteoporosis management among COPD patients. Methods An observational, prospective study was conducted on all medical admission ≥ 60 years old (n=50) with COPD in an Irish University Hospital for a period of 4 weeks in February 2025. Data analysis was performed using WEKA Explorer 3.8.6. Chi2 test was utilised to check for significance (p<0.05). Results 50% of patients sustained some form of fracture with vertebral fractures predominated (24%), followed by rib (12%), wrist (12%), hip (6%) and others (50%). 24% of patients had ≥2 fractures, with 38% sustaining major fractures. Only 58% of patients had vitamin D level tested. Of these, 58.9% were deficient (≤20 ng/mL) and 13.7% receiving no Vitamin D supplementation. 4% had calcium deficiency, yet none received calcium supplementation. Using NOGG criteria, 20% of patients were deemed high and very high risk of Major osteoporotic fracture, but only 30% received anti-osteoporotic treatment (p = .005). Conclusion The high vertebral fracture prevalence aligns with COPD’s systemic inflammation and muscle-bone crosstalk dysfunction, which accelerate bone resorption. The low rate of osteoporosis therapy indicates under-recognition of fracture risk, highlighting actionable gaps in osteoporosis care for COPD patients while emphasizing the need for guideline-driven interventions to reduce fracture-related morbidity.