Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture

Gonzalez AV, Coulombe J, Ernst P, Suissa S. Chest. 2018;153(2):321-8. [CrossRef] [PubMed]

It is uncertain whether long-term use of inhaled corticosteroids (ICSs), widely used to treat COPD, increases the risk of fracture, particularly in women, in view of the postmenopausal risks. The authors assessed whether long-term ICS use in patients with COPD increased the risk of hip or upper extremity fractures, and examined sex-related differences. A nested case-control analysis was used with each case of fracture was matched with 20 control subjects. In the cohort of 240,110 subjects, 19,396 sustained a fracture during a mean 5.3 years (rate, 15.2 per 1,000 per year). Any use of ICSs was not associated with an increased rate of fracture (RR, 1.00; 95% CI, 0.97-1.03). The fracture rate was increased with > 4 years of ICS use at daily doses > 1,000 mg in fluticasone equivalents (RR, 1.10; 95% CI, 1.02-1.19). This risk increase did not differ between men and women. The authors conclude that 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.