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The risk of osteoporosis in COPD: An analysis of sex differences and mediating effects based on NHANES
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  • Published: 07 March 2026

The risk of osteoporosis in COPD: An analysis of sex differences and mediating effects based on NHANES

  • Yongshan Gao1,2,
  • Zhikai Li1,3,
  • Jiahao Wu1,3,
  • Lin Du4,
  • Mengzhen Min5,
  • Liping Li2,
  • Xiaodong Chen2,
  • Zhigang Zhong1,3 &
  • …
  • Shangmin Chen1,2,3 

npj Primary Care Respiratory Medicine , Article number:  (2026) Cite this article

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  • Diseases
  • Endocrinology
  • Health care
  • Medical research
  • Risk factors

Abstract

Chronic obstructive pulmonary disease (COPD) and osteoporosis are significant public health concerns, often co-occurring due to shared risk factors such as ageing, smoking, and systemic inflammation, as well as treatment-related factors such as long-term glucocorticoid use. However, large-scale studies exploring these associations, their sex-specific effects, and mediating factors remain limited. A total of 8,274 participants aged ≥50 years from NHANES cycles 2005–2018 were included. COPD and osteoporosis were identified based on self-reported diagnoses, with Bone Mineral Density (BMD), measured by Dual-energy X-ray Absorptiometry (DXA), used as a sensitivity outcome. Weighted logistic regression analyzed the association between COPD and osteoporosis. Interaction and stratified analyses explored effect modification by sex, BMI, prednisone use, vitamin D, and race. Exploratory mediation analysis examined the indirect effects of prednisone, sleep problems, and vitamin D. COPD was significantly associated with osteoporosis risk (OR = 2.24, P < 0.001). A nominal sex interaction was observed (unadjusted P = 0.03), with a stronger association in males (adjusted OR = 4.85, 95% CI: 2.49–9.42, P < 0.001) than females (adjusted OR = 1.86, 95% CI: 1.30–2.65, P < 0.001). Exploratory mediation analyses suggested that prednisone use (mediated 5.1%) and sleep problems (mediated 9.3%) accounted for portions of the association, while vitamin D level did not show meaningful mediation. Sensitivity analyses confirmed an association between COPD and lower BMD (β = −0.032, P < 0.001), with significant mediation by prednisone (2.2%, P = 0.034). COPD is significantly associated with osteoporosis, with a stronger relative effect observed in males. Exploratory findings suggest potential mediation by prednisone use and sleep disorders. These results highlight the importance of integrated bone health management in COPD patients, with particular attention to sex-specific risks and modifiable factors such as glucocorticoid exposure and sleep quality.

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Data availability

This study used publicly available data from the National Health and Nutrition Examination Survey (NHANES). The datasets analysed are available from the NHANES website (https://www.cdc.gov/nchs/nhanes/) following the survey’s data-use guidelines.

References

  1. Organization, W. H. Chronic obstructive pulmonary disease (COPD), <https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)> (2024).

  2. Adeloye, D. et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir. Med. 10, 447–458 (2022).

    Google Scholar 

  3. Compston, J. E., McClung, M. R. & Leslie, W. D. Osteoporosis. Lancet 393, 364–376 (2019).

    Google Scholar 

  4. Johnell, O. & Kanis, J. A. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos. Int. 17, 1726–1733 (2006).

    Google Scholar 

  5. Zhao, G. et al. Potential drug targets for osteoporosis identified: A Mendelian randomization study. Heliyon 10, e36566. https://doi.org/10.1016/j.heliyon.2024.e36566 (2024).

    Google Scholar 

  6. Du, X. et al. Research progress in the mechanism of calcium ion on contraction and relaxation of airway smooth muscle cells. J. Recept. Signal. Transduct. Res. 41, 117–122 (2021).

    Google Scholar 

  7. Inoue, D., Watanabe, R. & Okazaki, R. COPD and osteoporosis: links, risks, and treatment challenges. Int. J. Chron. Obstruct Pulmon Dis. 11, 637–648 (2016).

    Google Scholar 

  8. Chan, Y. H., Teo, C. B., Tay, J. K. & Cheong, C. S. The association between obstructive sleep apnea and osteoporosis: A systematic review and meta-analysis. Sleep. Med. Rev. 78, 102006. https://doi.org/10.1016/j.smrv.2024.102006 (2024).

    Google Scholar 

  9. Kalyanaraman, H., Pal China, S., Casteel, D. E. & Pilz, R. B. Crosstalk between androgen receptor and protein kinase G signaling in bone: Implications for osteoporosis therapy. Trends Pharmacol. Sci. 46, 279–294 (2025).

    Google Scholar 

  10. Mohanty, S. et al. Molecular mechanisms and treatment strategies for estrogen deficiency-related and glucocorticoid-induced osteoporosis: a comprehensive review. Inflammopharmacology, https://doi.org/10.1007/s10787-025-01749-3 (2025).

  11. MacGregor, K. A., Gallagher, I. J. & Moran, C. N. Relationship between insulin sensitivity and menstrual cycle is modified by BMI, fitness, and physical activity in NHANES. J. Clin. Endocrinol. Metab. 106, 2979–2990 (2021).

    Google Scholar 

  12. Benowitz, N. L., Bernert, J. T., Caraballo, R. S., Holiday, D. B. & Wang, J. Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004. Am. J. Epidemiol. 169, 236–248 (2009).

    Google Scholar 

  13. Wang, D. & Yang, Y. The relationship between Serum 25-Hydroxyvitamin D levels and osteoporosis in postmenopausal women. Clin. Interv. Aging 18, 619–627 (2023).

    Google Scholar 

  14. Weinstein, R. S. Glucocorticoids, osteocytes, and skeletal fragility: The role of bone vascularity. Bone 46, 564–570 (2010).

    Google Scholar 

  15. Aguirre-Quezada, M. A., Aranda-Ramirez, M. P., Del Carmen-Garcia, M. & Reivan-Ortiz, G. Association of blood pressure with metabolic factors, stress levels, physical activity, and nutrient intake in overweight or obese ecuadorian university students: A study based on mediation analysis. Nutrients 18, 201 (2026).

    Google Scholar 

  16. Tang, D., Yang, J., Zhang, Y. & He, J. Q. Risk factors for sputum smear-positive in COPD patients first diagnosed with active tuberculosis. Microb. Pathog. 213, 108319 (2026).

    Google Scholar 

  17. Li, J., Zhao, H., Wang, F., Wang, C. & Pan, J. Socioeconomic status influences the relationship between residential green space and the risk of osteoporosis among rural adults: a large-scale population-based study. Front. Public. Health 13, 1695153 (2025).

    Google Scholar 

  18. Kurabayash, T. et al. Importance of changes in body mass index from adolescence to middle age as a risk factor for osteoporosis: the Japan Nurses’ Health Study. Menopause, https://doi.org/10.1097/GME.0000000000002740 (2026).

  19. Graumam, R. Q., Pinheiro, M. M., Nery, L. E. & Castro, C. H. M. Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity. Osteoporos. Int. 29, 1457–1468 (2018).

    Google Scholar 

  20. Wang, T. & He, C. TNF-alpha and IL-6: The Link between Immune and Bone System. Curr. Drug. Targets 21, 213–227 (2020).

    Google Scholar 

  21. Chen, T., Jin, L., Li, J. & Liu, Y. Pyroptosis mediates osteoporosis via the inflammation immune microenvironment. Front. Immunol. 15, 1371463 (2024).

    Google Scholar 

  22. Kaneki, H. et al. Tumor necrosis factor promotes Runx2 degradation through up-regulation of Smurf1 and Smurf2 in osteoblasts. J. Biol. Chem. 281, 4326–4333 (2006).

    Google Scholar 

  23. Azuma, Y., Kaji, K., Katogi, R., Takeshita, S. & Kudo, A. Tumor necrosis factor-alpha induces differentiation of and bone resorption by osteoclasts. J. Biol. Chem. 275, 4858–4864 (2000).

    Google Scholar 

  24. Zhang, H. et al. NOTCH inhibits osteoblast formation in inflammatory arthritis via noncanonical NF-kappaB. J. Clin. Invest. 124, 3200–3214 (2014).

    Google Scholar 

  25. Diarra, D. et al. Dickkopf-1 is a master regulator of joint remodeling. Nat. Med. 13, 156–163 (2007).

    Google Scholar 

  26. Wang, X. et al. N‑acetyl cysteine inhibits the lipopolysaccharide‑induced inflammatory response in bone marrow mesenchymal stem cells by suppressing the TXNIP/NLRP3/IL‑1beta signaling pathway. Mol. Med. Rep. 22, 3299–3306 (2020).

    Google Scholar 

  27. Wang, L. et al. NLRP3 inflammasome activation in mesenchymal stem cells inhibits osteogenic differentiation and enhances adipogenic differentiation. Biochem. Biophys. Res. Commun. 484, 871–877 (2017).

    Google Scholar 

  28. Kaneshiro, S. et al. IL-6 negatively regulates osteoblast differentiation through the SHP2/MEK2 and SHP2/Akt2 pathways in vitro. J. Bone Miner. Metab. 32, 378–392 (2014).

    Google Scholar 

  29. Franchimont, N., Gangji, V., Durant, D. & Canalis, E. Interleukin-6 with its soluble receptor enhances the expression of insulin-like growth factor-I in osteoblasts. Endocrinology 138, 5248–5255 (1997).

    Google Scholar 

  30. Yeh, L. C., Zavala, M. C. & Lee, J. C. Osteogenic protein-1 and interleukin-6 with its soluble receptor synergistically stimulate rat osteoblastic cell differentiation. J. Cell Physiol. 190, 322–331 (2002).

    Google Scholar 

  31. Ross, F. P. & Teitelbaum, S. L. alphavbeta3 and macrophage colony-stimulating factor: partners in osteoclast biology. Immunol. Rev. 208, 88–105 (2005).

    Google Scholar 

  32. Srivastava, R. K., Dar, H. Y. & Mishra, P. K. Immunoporosis: Immunology of osteoporosis-role of T cells. Front. Immunol. 9, 657 (2018).

    Google Scholar 

  33. Hodge, J. M., Collier, F. M., Pavlos, N. J., Kirkland, M. A. & Nicholson, G. C. M-CSF potently augments RANKL-induced resorption activation in mature human osteoclasts. PLoS one 6, e21462 (2011).

    Google Scholar 

  34. Theill, L. E., Boyle, W. J. & Penninger, J. M. RANK-L and RANK: T cells, bone loss, and mammalian evolution. Annu. Rev. Immunol. 20, 795–823 (2002).

    Google Scholar 

  35. Lam, J. et al. TNF-alpha induces osteoclastogenesis by direct stimulation of macrophages exposed to permissive levels of RANK ligand. J. Clin. Invest. 106, 1481–1488 (2000).

    Google Scholar 

  36. Takayanagi, H., Kim, S. & Taniguchi, T. Signaling crosstalk between RANKL and interferons in osteoclast differentiation. Arthritis Res. 4, S227–S232 (2002). Suppl 3.

    Google Scholar 

  37. Wong, B. R. et al. The TRAF family of signal transducers mediates NF-kappaB activation by the TRANCE receptor. J. Biol. Chem. 273, 28355–28359 (1998).

    Google Scholar 

  38. Takayanagi, H. et al. T-cell-mediated regulation of osteoclastogenesis by signalling cross-talk between RANKL and IFN-gamma. Nature 408, 600–605 (2000).

    Google Scholar 

  39. Cheung, W. Y., Liu, C., Tonelli-Zasarsky, R. M., Simmons, C. A. & You, L. Osteocyte apoptosis is mechanically regulated and induces angiogenesis in vitro. J. Orthop. Res. 29, 523–530 (2011).

    Google Scholar 

  40. Tang, M., Lu, L. & Yu, X. Interleukin-17A Interweaves the Skeletal and Immune Systems. Front. Immunol. 11, 625034 (2020).

    Google Scholar 

  41. Mansoori, M. N. et al. IL-18BP is decreased in osteoporotic women: Prevents Inflammasome mediated IL-18 activation and reduces Th17 differentiation. Sci. Rep. 6, 33680 (2016).

    Google Scholar 

  42. Palmqvist, P., Persson, E., Conaway, H. H. & Lerner, U. H. IL-6, leukemia inhibitory factor, and oncostatin M stimulate bone resorption and regulate the expression of receptor activator of NF-kappa B ligand, osteoprotegerin, and receptor activator of NF-kappa B in mouse calvariae. J. Immunol. 169, 3353–3362 (2002).

    Google Scholar 

  43. O’Brien, C. A., Lin, S. C., Bellido, T. & Manolagas, S. C. Expression levels of gp130 in bone marrow stromal cells determine the magnitude of osteoclastogenic signals generated by IL-6-type cytokines. J. Cell Biochem. 79, 532–541 (2000).

    Google Scholar 

  44. Kudo, O. et al. Interleukin-6 and interleukin-11 support human osteoclast formation by a RANKL-independent mechanism. Bone 32, 1–7 (2003).

    Google Scholar 

  45. Yoshitake, F., Itoh, S., Narita, H., Ishihara, K. & Ebisu, S. Interleukin-6 directly inhibits osteoclast differentiation by suppressing receptor activator of NF-kappaB signaling pathways. J. Biol. Chem. 283, 11535–11540 (2008).

    Google Scholar 

  46. Duplomb, L. et al. Interleukin-6 inhibits receptor activator of nuclear factor kappaB ligand-induced osteoclastogenesis by diverting cells into the macrophage lineage: key role of Serine727 phosphorylation of signal transducer and activator of transcription 3. Endocrinology 149, 3688–3697 (2008).

    Google Scholar 

  47. Alam, M. I. et al. NLRP3 inflammasome negatively regulates RANKL-Induced osteoclastogenesis of mouse bone marrow macrophages but positively regulates it in the presence of lipopolysaccharides. Int. J. Mol. Sci. 23, 6096 (2022).

    Google Scholar 

  48. Ding, J. et al. Pore-forming activity and structural autoinhibition of the gasdermin family. Nature 535, 111–116 (2016).

    Google Scholar 

  49. Wu, Y. L. et al. Propionate and butyrate attenuate macrophage pyroptosis and osteoclastogenesis induced by CoCrMo alloy particles. Mil. Med. Res. 9, 46 (2022).

    Google Scholar 

  50. Place, D. E. & Kanneganti, T. D. Recent advances in inflammasome biology. Curr. Opin. Immunol. 50, 32–38 (2018).

    Google Scholar 

  51. Coll, R. C. et al. A small-molecule inhibitor of the NLRP3 inflammasome for the treatment of inflammatory diseases. Nat. Med. 21, 248–255 (2015).

    Google Scholar 

  52. Ni, B. et al. MCC950, the NLRP3 inhibitor, protects against cartilage degradation in a mouse model of osteoarthritis. Oxid. Med. Cell Longev. 2021, 4139048 (2021).

    Google Scholar 

  53. Jilka, R. L. et al. Increased osteoclast development after estrogen loss: mediation by interleukin-6. Science 257, 88–91 (1992).

    Google Scholar 

  54. Roggia, C. et al. Up-regulation of TNF-producing T cells in the bone marrow: a key mechanism by which estrogen deficiency induces bone loss in vivo. Proc. Natl Acad. Sci. USA 98, 13960–13965 (2001).

    Google Scholar 

  55. Wang, D., Ruan, W., Peng, Y. & Li, W. Sleep duration and the risk of osteoporosis among middle-aged and elderly adults: a dose-response meta-analysis. Osteoporos. Int. 29, 1689–1695 (2018).

    Google Scholar 

  56. Irwin, M. R., Olmstead, R. & Carroll, J. E. Sleep disturbance, sleep duration, and inflammation: A systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol. Psychiatry 80, 40–52 (2016).

    Google Scholar 

  57. D’Cruz, R. F., Murphy, P. B. & Kaltsakas, G. Sleep disordered breathing and chronic obstructive pulmonary disease: A narrative review on classification, pathophysiology and clinical outcomes. J. Thorac. Dis. 12, S202–S216 (2020).

    Google Scholar 

  58. Li, S. Q. et al. Impact of insomnia and obstructive sleep apnea on the risk of acute exacerbation of chronic obstructive pulmonary disease. Sleep. Med. Rev. 58, 101444 (2021).

    Google Scholar 

  59. Humphrey, M. B. et al. 2022 American college of rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res. 75, 2405–2419 (2023).

    Google Scholar 

  60. Balasubramanian, A. et al. Glucocorticoid exposure and fracture risk in a cohort of US patients with selected conditions. J. Bone Min. Res. 33, 1881–1888 (2018).

    Google Scholar 

  61. Tanaka, Y. et al. The 2023 Guidelines for the management and treatment of glucocorticoid-induced osteoporosis. J. bone Miner. Metab. 42, 143–154 (2024).

    Google Scholar 

  62. Ru, J. Y. & Wang, Y. F. Osteocyte apoptosis: the roles and key molecular mechanisms in resorption-related bone diseases. Cell Death Dis. 11, 846 (2020).

    Google Scholar 

  63. Hu, L. et al. Mesenchymal stem cells: Cell fate decision to osteoblast or adipocyte and application in osteoporosis treatment. Int. J. Mol. Sci. 19, 360 (2018).

    Google Scholar 

  64. Lee, J. E., Park, S., Kim, Y., Wi, S. & Kim, Y. T. Novel evidence in vivo: Berberine ameliorated glucocorticoid-induced post-natal growth retardation by regulating the GH/IGF-1 axis through KMT1A downregulation. Toxicol. Appl. Pharmacol. 500, 117362 (2025).

    Google Scholar 

  65. Locatelli, V. & Bianchi, V. E. Effect of GH/IGF-1 on Bone Metabolism and Osteoporsosis. Int. J. Endocrinol. 2014, 235060 (2014).

    Google Scholar 

  66. Chen, Y. C., Greenbaum, J., Shen, H. & Deng, H. W. Association between gut microbiota and bone health: Potential mechanisms and prospective. J. Clin. Endocrinol. Metab. 102, 3635–3646 (2017).

    Google Scholar 

  67. Dong, Y. et al. Modulation of the gut-bone axis: Lacticaseibacillus paracasei LC86 improves bone health via anti-inflammatory metabolic pathways in zebrafish models of osteoporosis and cartilage damage. Front. Immunol. 16, 1493560 (2025).

    Google Scholar 

  68. Paccou, J. et al. Prevention and treatment of glucocorticoid-induced osteoporosis in adults: recommendations from the European Calcified Tissue Society. Eur. J. Endocrinol. 191, G1–G17 (2024).

    Google Scholar 

  69. Khan, M., Jose, A. & Sharma, S. in StatPearls (2025).

  70. Aryal, S., Diaz-Guzman, E. & Mannino, D. M. COPD and gender differences: an update. Transl. Res. 162, 208–218 (2013).

    Google Scholar 

  71. Su, L. et al. Association between systemic immune inflammation index and serum testosterone and free testosterone in middle-aged and elderly men. Andrology, https://doi.org/10.1111/andr.70036 (2025).

  72. Cover, P. O., Baanah-Jones, F., John, C. D. & Buckingham, J. C. Annexin 1 (lipocortin 1) mimics inhibitory effects of glucocorticoids on testosterone secretion and enhances effects of interleukin-1beta. Endocrine 18, 33–39 (2002).

    Google Scholar 

  73. O’Brien, C. J. O. Macrophage regulation of hypothalamic-pituitary-adrenal and gonadal axis homeostasis and hormonal output. Biomed J, 100866, https://doi.org/10.1016/j.bj.2025.100866 (2025).

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Acknowledgements

We would like to express our sincere thanks to all participants in the NHANES survey. This research was supported by the 2024 Shantou Science and Technology Plan Medical and Health Project (Grant No: 240506186498668, 240922169602002).

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Authors and Affiliations

  1. Sports Medicine Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China

    Yongshan Gao, Zhikai Li, Jiahao Wu, Zhigang Zhong & Shangmin Chen

  2. School of Public Health, Shantou University, Shantou, China

    Yongshan Gao, Liping Li, Xiaodong Chen & Shangmin Chen

  3. Sports Medicine Institute, Shantou University Medical College, Shantou, China

    Zhikai Li, Jiahao Wu, Zhigang Zhong & Shangmin Chen

  4. Centre for Orthopaedic Research, School of Biomedical Sciences, The University of Western Australia, Nedlands, WA, Australia

    Lin Du

  5. The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Mengzhen Min

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Contributions

YG: Conceptualization, Data curation, Formal Analysis, Visualization, Software, Writing - original draft, Writing - review & editing. JW: Data curation, Software, Visualization, Writing - review & editing. ZL: Data curation, Writing - review & editing. LD: Data curation, Conceptualization, Writing - review & editing. MM: Methodology, Supervision, Writing - review & editing. LL: Conceptualization, Methodology, Writing - review & editing. XC:Methodology, Writing - review & editing. ZZ: Conceptualization, Methodology, Project administration, Supervision, Writing - review & editing. SC: Project administration, Methodology, Supervision, Funding acquisition, Writing - review & editing.

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Correspondence to Xiaodong Chen, Zhigang Zhong or Shangmin Chen.

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Gao, Y., Li, Z., Wu, J. et al. The risk of osteoporosis in COPD: An analysis of sex differences and mediating effects based on NHANES. npj Prim. Care Respir. Med. (2026). https://doi.org/10.1038/s41533-026-00490-w

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  • Received: 29 September 2025

  • Accepted: 03 February 2026

  • Published: 07 March 2026

  • DOI: https://doi.org/10.1038/s41533-026-00490-w

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