Long-Term Inhaled Corticosteroid Use Modestly Increases Fracture Risk in COPD Patients

Long-term use of inhaled corticosteroids at high doses is associated with a modestly increased risk of hip and upper extremity fractures in patients with chronic obstructive pulmonary disease (COPD), according to a recent study.

Little research is available about whether long-term use of inhaled corticosteroids increases the risk of fracture, especially in women due to postmenopausal risks.
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To explore this risk further, the researchers assessed 240,110 patients enrolled in Quebec health care databases from 1990 to 2005. Patients were followed until 2007 for the first hip or upper extremity fracture.

In a nested case-control analysis, each case of fracture was matched with 20 controls based on age, sex, and follow-up time. Using conditional logistic regression, the researchers estimated the adjusted rate ratio of fracture with inhaled corticosteroid use by duration and dose, with an interaction term to compare the risk in men and women.

Results indicated that 19,396 patients sustained a fracture over a mean 5.3 years. Overall, any use of inhaled corticosteroids was not associated with an increased rate of fracture. However, the researchers found that the fracture rate had increased with use at daily doses of 1000 μg or higher for 4 years or longer in fluticasone equivalents. They noted that this risk increase did not differ between men and women.

“Long-term [inhaled corticosteroid] use at high doses is associated with a modest increase in the risk of hip and upper extremity fractures in patients with COPD,” the researchers concluded. “This dose-duration risk increase does not appear to be higher for women.”

—Christina Vogt

Reference:

Gonzalez AV, Coulombe J, Ernst P, Suissa S. Long-term use of inhaled corticosteroids in COPD and the risk of fracture [Published online July 14, 2017]. Chest. doi:10.1016/j.chest.2017.07.002.