Abstract Background While the association between respiratory disease and bone health is well established in disorders such as cystic fibrosis and chronic obstructive pulmonary disease (COPD), there is a paucity of robust data regarding osteoporosis and fracture risk in non-cystic fibrosis bronchiectasis (NCFB). This study aimed to address this knowledge gap using a large real-world healthcare dataset. Methods We conducted a retrospective cohort analysis using the TriNetX electronic health record network. Adults with NCFB were identified by International Classification of Diseases, Tenth Revision (ICD-10) code J47, confirmed with thoracic computed tomography (CT) imaging (CPT codes 71250, 71260, 71270), and excluding those with cystic fibrosis (E84). The reference cohort consisted of adults without NCFB, specifically those presenting for routine encounters (ICD-10 Z02). Primary outcomes were new diagnoses of osteoporosis without fracture (ICD-10 M81) and fragility fracture (ICD-10 M80, M84.4, Z87.310). Comparisons assessed incident events between NCFB and non-NCFB groups. To minimize confounding, 1:1 propensity score matching was performed using age, sex, race, ethnicity, diabetes (E08-E13), thyroid disease (E00-E07), tobacco use (F17), alcohol use (F10), lower socioeconomic status (Z55-Z65), underweight (BMI 20, Z68.1), and rheumatoid arthritis (M05). Sensitivity analyses used a broader definition of NCFB without chest CT. Results Across 207,945 NCFB patients from 2014-2024, annual osteoporosis incidence increased from 1.85% to 3.61%, while fragility fracture incidence rose from 0.44% to 1.19%. After propensity score matching, the analysis included 162,488 adults with NCFB and 172,035 adults without NCFB for the osteoporosis outcome, with 17,739 (10.9%) and 12,920 (7.5%) experiencing osteoporosis, respectively (risk ratio RR 1.45, 95% confidence interval CI 1.42-1.49). For fragility fracture, there were 188,652 NCFB and 190,591 controls, with 7,001 (3.7%) and 5,044 (2.7%) events (RR 1.40, 95% CI 1.37-1.47). Sensitivity analyses, using a definition of NCFB without requiring chest CT, confirmed elevated risks for both osteoporosis (RR 1.30, 95% CI 1.27-1.32) and fracture (RR 1.13, 95% CI 1.10-1.16). Conclusions Non-cystic fibrosis bronchiectasis is associated with a substantially increased risk of osteoporosis and fragility fracture. These findings set the stage for targeted screening and bone health interventions in NCFB. Integrating bone health evaluation into routine care pathways for NCFB may address an underrecognized source of morbidity and improve patient outcomes. This analysis also supports integrating bone health assessment into multidisciplinary bronchiectasis management guidelines. However, as with all database studies, potential for residual confounding remains, even after matching. This abstract is funded by: None
Doumat et al. (2026) studied this question.