FRAXing the Gap: Revealing Missed Osteoporosis Treatment in COPD Admissions

Abstract Background Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of osteoporosis, with vertebral compression fractures contributing to reduced pulmonary function. While the association between inhaled corticosteroids and osteoporosis remains inconclusive, NICE guidelines advocate for osteoporosis prevention in patients frequently prescribed oral corticosteroids. This audit aimed to assess osteoporosis risk in COPD patients using the FRAX tool and evaluate treatment rates in those identified as high risk. Methods A cross-sectional audit conducted in March 2025 included COPD patients aged >60 years admitted to an Irish university hospital. Osteoporosis risk was assessed using the FRAX tool, with stratification based on National Osteoporosis Guideline Group (NOGG) recommendations. Statistical analysis was performed using DATAtab, with ANOVA applied for significance testing. Results Fifty-two patients were included (65% male; median age 79.5 ± 8.19 years). Only 10% were on regular oral corticosteroids, yet 92% had ≥1 steroid-requiring exacerbation in the past year (mean 2.1 ± 1.68; max 8). Higher exacerbation frequency correlated with increased fracture risk (p<0.001). The mean 10-year probability of major osteoporotic and hip fractures was 14.9% ± 10.04 and 8.89% ± 8.25, respectively. Based on NOGG, 20% were deemed at high risk of fracture and 30% warranted osteoporosis treatment; yet only 44% of these were on treatment. Of those for whom bone density assessment was recommended, only 15% underwent testing. Conclusion The audit highlights suboptimal adherence to osteoporosis screening and treatment guidelines in COPD patients. Enhanced implementation of FRAX-based risk assessment and targeted intervention could reduce fracture risk and improve outcomes in this vulnerable cohort.