Long-Term Use of COPD Medication Associated With Risk of Fractures

Long-term use of inhaled corticosteroids (ICS), which are widely used to treat chronic obstructive pulmonary disease (COPD), are associated with an increased risk of fractures, according to a new study in CHEST.

Previous research has found that use of ICS has a negative impact on bone mineral density, and the researchers sought to determine if long-term use of ICSs not only increased the risk of hip or upper extremity fractures, but also if the increase risk differs between men and postmenopausal women. While postmenopausal women are already susceptible to decreased bone density, it is unclear if this translates to bone fractures.

The study included 240,110 patients age 55 years and older. During the follow-up (mean 5.3 years), there were 19,396 cases of fracture, which were age- and sex-matched to 384,478 control person-moments. Nearly three-fourths (72%) of subjects were women.

The rate of fracture in women was 20.4 per 1000 per year compared with 9.2 per 1000 for men. The authors did not note any significant difference in the rate of fractures associated with ICS use between men and women.

"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, PhD, lead researcher and professor at McGill University, said in a statement. "Quantifying this excess number would require a larger cohort."

Osteoporosis is a common comorbidity in patients who have COPD, but even though ICS is recommended in selected patients with COPD, “overprescription of ICSs is a reality.” The fact that there is frequent ICS use in patients with a low risk of exacerbations has made it necessary to clarify the impact of ICS use on fracture risk, the authors explained.

“Clinicians need to carefully consider the benefits and risks of prescribing ICSs to patients with COPD, particularly over the longer term, and the prescribed dose should be kept as low as possible,” the authors concluded.

References

Gonzalez AV, Coulombe J, Ernst P, Suissa S. Long-term use of inhaled corticosteroids in COPD and the risk of fracture. Chest. 2018;153(2):321-328. doi: https://doi.org/10.1016/j.chest.2017.07.002.