Management of Fracture Risk in Patients with Chronic Obstructive Pulmonary Disease (COPD): Building a UK Consensus Through Healthcare Professional and Patient Engagement
Received 4 October 2019
Accepted for publication 23 March 2020
Published 15 June 2020 Volume 2020:15 Pages 1377—1390
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 4
Editor who approved publication: Dr Richard Russell
Ayushman Gupta, 1 Leah R Jayes, 2 Steve Holmes, 3 Opinder Sahota, 4 Melissa Canavan, 5 Sarah L Elkin, 6 Kelvin Lim, 7 Anna C Murphy, 8 Sally Singh, 9, 10 Elizabeth A Towlson, 11 Helen Ward, 12 Jane Scullion, 9 Tricia M McKeever, 2 Charlotte E Bolton 1
1NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK; 2Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK; 3General Practitioner, Park Medical Partnership, Shepton Mallet, UK; 4Department of Geriatric Medicine, Nottingham University Hospitals Trust, Nottingham, UK; 5Department of Respiratory, Respiratory Care Solutions, Leeds, UK; 6Department of Respiratory Medicine, Imperial College Healthcare Trust, London W2 1NY, UK; Airways Section, National Heart and Lung Institute, Imperial College, London, UK; 7Eastwood Primary Care Centre, Eastwood, Nottingham, UK; 8Department of Pharmacy, University Hospitals of Leicester NHS Trust, Leicester, UK; 9Department of Respiratory Science, University Hospitals of Leicester NHS Trust, Leicester, UK; 10Department of Respiratory Science, University of Leicester, Leicester, UK; 11Respiratory Nurse, Saxon Cross Surgery, Stapleford, Nottingham, UK; 12Faculty of Medicine, The Royal Wolverhampton NHS Trust, West Midlands, UK
Correspondence: Ayushman Gupta
NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
Introduction: Osteoporosis and bone fractures are common in chronic obstructive pulmonary disease (COPD) and contribute significantly to morbidity and mortality. Current national guidance on COPD management recommends addressing bone health in patients, however, does not detail how. This consensus outlines key elements of a structured approach to managing bone health and fracture risk in patients with COPD.
Methods: A systematic approach incorporating multifaceted methodologies included detailed patient and healthcare professional (HCP) surveys followed by a roundtable meeting to reach a consensus on what a pathway would look like.
Results: The surveys revealed that fracture risk was not always assessed despite being recognised as an important aspect of COPD management by HCPs. The majority of the patients also stated they would be receptive to discussing treatment options if found to be at risk of osteoporotic fractures. Limited time and resource allocation were identified as barriers to addressing bone health during consultations. The consensus from the roundtable meeting was that a proactive systematic approach to assessing bone health should be adopted. This should involve using fracture risk assessment tools to identify individuals at risk, investigating secondary causes of osteoporosis if a diagnosis is made and reinforcing non-pharmacological and preventative measures such as smoking cessation, keeping active and pharmacological management of osteoporosis and medicines management of corticosteroid use. Practically, prioritising patients with important additional risk factors, such as previous fragility fractures, older age and long-term oral corticosteroid use for an assessment, was felt required.
Conclusion: There is a need for integrating fracture risk assessment into the COPD pathway. Developing a systematic and holistic approach to addressing bone health is key to achieving this. In tandem, opportunities to disseminate the information and educational resources are also required.
Keywords: COPD, fracture risk, osteoporosis, bone health
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