Long-term Use of Inhaled Corticosteroids May Increase Risk of Bone Fractures

Using long-term inhaled corticosteroids to relieve inflammation in chronic obstructive pulmonary disease (COPD) could increase the risk of bone fractures, new research suggests.

A study published in the journal CHEST, “Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture,” was conducted by researchers from McGill University and the Montreal Jewish General Hospital-Lady Davis Research Institute. They used data from the Quebec healthcare databases to form a group of COPD patients from 1990 to 2005, and were followed until 2007 for a hip or upper extremity fracture.

Previous studies have reported that inhaled corticosteroids (ICS) use has a negative impact on bone mineral density, especially in post-menopausal women. However, ICS’ direct effect on bone fracture has  not been assessed.

So, researchers analyzed COPD patients, 55 years and older, who had been followed for the occurrence of hip or upper extremity fracture. Researchers also conducted a case-control analysis in which each case of fracture was matched with 20 “control” study participants regarding age, sex and follow-up time.

The team found that long-term ICS exposure at high doses was linked to considerable increased risk of hip or upper extremity fractures.

Of the 240,110 COPD patients enrolled in the study, 19,396 sustained a fracture during a mean of 5.3 years. Rates were higher for those who used ICS for a period longer than four years at daily doses of 1,000 mcg or more. Both men and women with COPD were affected equally.

The findings follow previous studies suggesting that ICS negatively impacts bone mineral density in a dose-dependent manner. Previous studies also had suggested that post-menopausal women were more affected by the loss of bone mineral density.

“Since fractures are more frequent in women than men, our study suggests that the excess number of fractures associated with ICS will be greater in women even though we did not find that the risk increase was particularly higher in women than in men,” Samy Suissa, lead researcher of the study, said in a press release. “Quantifying this excess number would require a larger cohort [group].”

Based on the results, the team concluded: “Long-term ICS use at high doses is associated with a modest increase in the risk of hip and upper extremity fractures in patients with COPD. This dose-duration risk increase does not appear to be higher for women.”

ICS are used to reduce inflammation in the airways and reduce mucus build-up. They are used frequently to treat COPD.