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Study: Long-term inhaled corticosteroid use increases fracture risk in lung disease patients

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Sonal Singh

Patients with chronic obstructive pulmonary disease who use inhaled corticosteroids to improve breathing for more than 6 months demonstrated a 27% increased risk of fracture, according to Johns Hopkins Medical Institutions researchers.

The authors claimed the findings, based on their cohort of patients who were mostly male, aged 60 years and older, raise questions about the medication’s impact on women with chronic obstructive pulmonary disease (COPD).

“There are millions of COPD patients who use long-term inhaled corticosteroids in the United States and millions more across the world,” study author Sonal Singh, MD, MPH, stated in the release. “The number of people who are getting fractures because of these medications is quite large.”

The study, published online in Thorax, investigated the inhaled corticosteroids fluticasone and budesonide. Singh and his team performed a review of two sets of research studies that compared inhaled corticosteroids to a placebo in COPD patients. One looked at 16 — 14 fluticasone and 2 budesonide — long-term double-blind randomized controlled trials with a total of 17,153 participants; the other examined seven observational studies with a total of 69,000 participants.

Th team found inhaled corticosteroids to significantly increase the risk of fracture in the randomized controlled trials and observational studies. Further, each 500 ìg increase in exposure to beclomethasone equivalents was associated with a 9% increase in fracture risk in the observational studies.

“People who continue to use inhaled corticosteroids should pay attention to bone health and consider the lowest possible dose for the shortest possible time. The risks may be somewhat mitigated with bone-building drugs,” Singh stated.

Singh noted in the release, the greatest concern is with those who were not the focus of his study: women.

“It was surprising to find an increased risk of fractures in this study where two-thirds of the participants were men over the age of 60,” he stated. “It makes us wonder what is happening to men with COPD who use inhalers, because older women are already at a much higher fracture risk than men.”

Reference:

• Loke YK, Cavallazzi R, Singh S. Risk of fractures with inhaled corticosteroids in COPD: Systematic review and meta-analysis of randomised controlled trials and observational studies. Thorax. 2011. Epub ahead of print.
• www.hopkinsmedicine.org

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