Abstract

Abstract
Patients with COPD are particularly vulnerable to developing osteoporosis due to oral corticosteroid (OCS) use and factors including smoking history, older age, and sedimentary lifestyles. Bisphosphonates mitigate this risk by slowing bone turn over and reducing the risk of fractures. Lack of specific osteoporosis guidelines could delay treatment of avoidable osteoporotic fractures and could consequently lower their quality of life. Exploration of bisphosphonate prescription patterns and impacts on bone mineral density (BMD) in COPD patients in the UK and globally could contribute to prescription guidelines and advice to reduce this risk.

Methods
A literature search of publications from 1946 to 2004 of Cinhal, Embase, OVID MEDLINE, Scopus, and Web of Science was conducted using the search terms and inclusion/exclusion criteria. Reporting of the findings was completed using the PRISMA checklist and bias was assessed using the RoB2 and ROBINS-I tool.

Results
From 736 papers, only six met the eligibility criteria. Three population-database studies determined the prescriptive patterns of bisphosphonates, involving 6586 practices and 390, 223 patients. One randomised control trial (RCT) and two retrospective cohort studies of 405 patients explored the impacts of bisphosphonates. COPD was found to be significantly associated with bisphosphonate prescriptions, unlike patients with asthma. Results also suggest COPD patients using corticosteroids were more likely to be prescribed bisphosphonates. Significant improvements in BMD in the lumbar and femoral regions appears to show bisphosphonates have a positive impact on BMD in COPD patients compared with non-users.



Conclusion
Studies suggest high bisphosphonate prescriptions were associated with corticosteroids use in COPD patients. Bisphosphonates were shown to improve BMD in certain regions compared to non-treatment groups. Region-specific observational studies are required to observe reasons for differing prescribing patterns. Longer-term extensive RCT’s of different bisphosphonates and dosages could test efficacy and provide a basis for COPD specific guidelines.