Does Long-Term ICS Use Increase Fracture Risk in COPD Patients?

Long-term ICS exposure at high doses was associated with a modest but significant increase in the risk of hip or upper extremity fractures.

Findings from a study published in CHEST show that long-term inhaled corticosteroid (ICS) use at high doses may be associated with a slight increase in the risk of hip and upper extremity fractures in patients with chronic obstructive pulmonary disease (COPD). 

To get a better understanding on how ICS use impacts fracture risk, researchers from McGill University and the Jewish General Hospital-Lady Davis Research Institute formed a cohort of adults ≥55 years old with COPD over 1990–2005 and followed them until 2007 for the first occurrence of hip or upper extremity fracture. A nested case-control analysis was conducted which matched each case of fracture incidence with 20 control subjects. 

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The data revealed a modest but significant increase in hip or upper extremity fractures with pronged ICS use at high doses. Within the cohort (N=240,110), 19,396 patients sustained a fracture during an average 5.3 years (rate: 15.2 per 1,000 per year). Prolonged use of ICS at high doses (>4 years at daily doses of ≥1000mcg fluticasone equivalents) was associated with an overall 10% increase in fracture risk (rate ratio [RR] 1.10, 95% CI: 1.02–1.19); the risk increase was similar for both male and female COPD patients.

Based on these findings, the authors state that “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.”

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