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Am. J. Respir. Crit. Care Med., Volume 157, Number 3, March 1998, 704-709

Association between Corticosteroid Use and Vertebral Fractures in Older Men with Chronic Obstructive Pulmonary Disease

CHARLENE E. MCEVOY, KRISTINE E. ENSRUD, EARL BENDER, HARRY K. GENANT, WEI YU, JAYNE M. GRIFFITH, and DENNIS E. NIEWOEHNER

Section of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Minnesota Medical School; Sections of General Internal Medicine and Pulmonary Medicine, Department of Medicine, and Department of Radiology, VA Medical Center; Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota; and Departments of Radiology and Medicine, University of California, San Francisco, California

Osteoporosis is a major complication of long-term corticosteroid administration, but the magnitude of the effect in patients with chronic obstructive pulmonary disease (COPD) is not well defined. In a cross-sectional study, we evaluated the association between steroid use and vertebral fractures in 312 men, 50 yr of age or older, with COPD. Subjects were evaluated according to their corticosteroid use: Never Steroid Users (NSU) (n = 117), Inhaled Steroid Users (ISU) (n = 70), and Systemic Steroid Users (SSU) (n = 125). The prevalence of one or more vertebral fractures was 48.7% in the NSU group, 57.1% in the ISU group, and 63.3% in the SSU group. Compared with NSU, SSU were two times as likely to have one or more vertebral fractures: age-adjusted odds ratio (OR) = 1.80; 95% CI, 1.08 to 3.07. This relationship was primarily due to a strong association between continuous systemic steroid use and vertebral fractures: age-adjusted OR = 2.36; 95% CI, 1.26 to 4.38. In addition, fractures in SSU were more likely to be multiple and more severe. A weaker relationship existed between inhaled steroid use and vertebral fractures: age-adjusted OR = 1.35; 95% CI, 0.77 to 2.56 compared with NSU. These data indicate that vertebral fractures are common in older men with COPD; the likelihood of these fractures is greatest in those men using continuous systemic steroids. McEvoy CE, Ensrud KE, Bender E, Genant HK, Yu W, Griffith JM, Niewoehner DE. Association between corticosteroid use and vertebral fractures in older men with chronic obstructive pulmonary disease.




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