Bone mineral density (BMD) alone does not reliably predict osteoporotic 
fractures. The Fracture Risk Assessment Tool (FRAX) was developed to estimate 
the risk of fracture in the general population. This study was designed to 
identify predictors of osteoporosis and vertebral fractures in patients 
presenting with chronic obstructive pulmonary disease (COPD). We studied 85 
patients (mean age = 75 years; 92% men) with moderate to very severe COPD. 
Osteoporosis and vertebral fractures were diagnosed with dual energy X-ray 
absorptiometric scan and vertebral X-rays, respectively. Patient 
characteristics, including age, gender, body mass index (BMI), and results of 
pulmonary function tests, chest computed tomography scan, blood and urinary 
biomarkers of bone turnover were recorded, and a FRAX score was calculated by a 
computer-based algorithm. Osteoporosis, defined as a T score < -2.5, found in 20 
patients (24%), was associated with female gender, BMI, dyspnea scale, long-term 
oxygen therapy (LTOT), vital capacity (VC), emphysema score on computed 
tomography, measurements of serum and urinary biomarkers of bone turnover. 
Vertebral fractures, diagnosed in 29 patients (35%), were strongly correlated 
with age, LTOT, VC, and forced expiratory volume in 1 sec, treatment with oral 
corticosteroid or warfarin, and weakly associated with the presence of 
osteoporosis. There was no correlation between FRAX score and prevalence of 
vertebral fractures, suggesting that neither BMD alone nor FRAX score would 
predict the presence of vertebral fractures in COPD patients. A disease-specific 
algorithm to predict osteoporotic fractures is needed to improve the management 
of patients suffering from COPD.