Long-term inhaled corticosteroid use linked to hip fracture risk

Patients who used long-term inhaled corticosteroids to treat their COPD were at moderately higher risk for upper extremity and hip fractures, according to findings published in Chest.

“Inhaled corticosteroids are known to reduce bone mineral density, but whether their use increases the risk of fractures is less clear,” Anne V. Gonzalez, MD, of the respiratory epidemiology and clinical research unit at the Montreal Chest Institute, told Healio Family Medicine in an interview. “In particular, few studies previously examined the effect of long-term inhaled corticosteroid use on risk of fracture, and none looked at the risk in postmenopausal women vs. men.”

Researchers noted that osteoporosis is common in patients with COPD, with a previous study finding that the prevalence of osteoporosis in such patients was 18% in men and 30% in women.

In the current study, Gonzalez and colleagues studied a cohort of 240,110 patients at least 55 years of age who initiated treatment for COPD between 1990 and 2005 and received three or more prescriptions for inhaled corticosteroids, theophylline, anticholinergics and beta-agonists in any 1-year period and were prescribed these medications on at least two different occasions. Patients were followed for 2 years after the cohort’s end to see whether an upper extremity or hip fracture occurred.

Gonzalez and colleagues found that 19,396 patients experienced a fracture. For all patients who received inhaled corticosteroids, there was no significant increase in fracture rate (RR = 1; 95% CI, 0.97-1.03). However, among high-dose users - those with 4 years of daily use of at least 1,000 µg in fluticasone equivalents - the rate of fracture increased 10% (RR = 1.1; 95% CI, 1.02-1.19). Researchers also wrote that although no difference in fracture risk between women and men was observed, since the rate of fracture is higher in women, those women who use high doses of inhaled corticosteroids would lead to additional fractures.

Gonzalez provided some suggestions on how primary care physicians can be more proactive in lowering fracture risk for patients with COPD.

“Use of inhaled corticosteroids is recommended for the subgroup of patients with frequent exacerbation, or the asthma-COPD overlap syndrome,” she said in the interview. “Clinicians need to consider the indications, expected benefits and risks of prescribing inhaled corticosteroids to patients with COPD, particularly over the long term, and the prescribed dose should be kept as low as possible.” – by Janel Miller

Disclosures: Gonzalez reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.