COPD O-009 : The Acute Exacerbation of COPD Increases the Risk of Hip Fracture: Nested Case-control Study from KNHIS (Korea National Health Insurance Service)

Background/Aims In chronic obstructive pulmonary disease (COPD) patients, it was known that the hip fracture increased more than non-COPD patients. The main causes of hip fracture in COPD patients were known systemic corticosteroid, low body mass and smoking. However, there seems to be another factor involved in the hip fracture in COPD patients. Therefore, we would like to study the effect of acute exacerbation of COPD on hip fracture. Methods This retrospective, nested case-control study included 253,471 COPD patients with COPD at least 40 years old, retrieved from Korea National Health Insurance Service (NHIS) for health care claims from 2002 to 2015. Among them, 176,598 cohorts were formed to fit the definition of COPD, and 1,415 patients were compared by matching 1:1 according to the presence of hip fracture. Results The use of systemic corticosteroid for more than 90 days increases the risk of hip fracture regardless of acute exacerbation events (OR, 2.94; 95% CI 1.81-4.78). In addition, if COPD patients had both 1 more acute exacerbation events and use of systemic corticosteroid for more than 90 days the risk of hip fracture was increased (OR, 4.44; 95% CI 1.48-13.29). The risk of hip fracture increased if there was 1 acute exacerbation in 1 year prior to the hip fracture (OR, 2.25; 95% CI 1.66-3.05). In patients with more than 2 acute exacerbation 1 year prior to the hip fracture, the risk of the hip fracture also increased (OR, 2.57; 95% CI 1.61-4.10). The patients with AE-COPD the hip fracture increased by 2.50 times regardless of systemic corticosteroid and underlying disease. (OR, 2.50; 95% CI, 1.67 - 3.75). Conclusion The acute exacerbation of COPD increase the risk of hip fracture regardless of underlying diseases including osteoporosis and systemic corticosteroid.