Background
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. We assessed whether long-term ICS use in patients with COPD
increases the risk of hip or upper extremity fractures, and examined sex-related differences.
Methods
The Quebec health-care databases were used to form a cohort of patients with COPD
over 1990 to 2005, 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 control
subjects on age, sex, and follow-up time. The adjusted rate ratio (RR) of fracture
with ICS use, by duration and dose, was estimated using conditional logistic regression,
with an interaction term to compare the risk in men and women.
Results
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 μg in fluticasone equivalents (RR, 1.10;
95% CI, 1.02-1.19). This risk increase did not differ between men and women.
Conclusions
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.
Key Words
Abbreviations:
ICS ( inhaled corticosteroid), RAMQ ( Régie de l'assurance maladie du Québec), RR ( rate ratio)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: July 14, 2017
Footnotes
FUNDING/SUPPORT: This study was funded in part by grants from the Canadian Institutes of Health Research [Grant CIHR MOP-49462], Canadian Foundation for Innovation [Grant CFI 94480], and by financial support from Novartis Pharmaceuticals Canada Inc. A. V. G. is the recipient of an FRQS chercheur-boursier clinicien award, and S. S. is the recipient of the James McGill Professorship award.
Identification
Copyright
© 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
