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Published ahead of print on January 7, 2004, doi:10.1164/rccm.200307-926OC
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American Journal of Respiratory and Critical Care Medicine Vol 169. pp. 855-859, (2004)
© 2004 American Thoracic Society

Original Article

Fracture Risk Associated with Inhaled Corticosteroid Use in Chronic Obstructive Pulmonary Disease

Todd A. Lee and Kevin B. Weiss

Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines; Center for Healthcare Studies, Division of General Internal Medicine, and the Department of Medicine, Feinberg School of Medicine, Northwestern University; and Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois

Correspondence and requests for reprints should be addressed to Todd A. Lee, Pharm.D., Ph.D., Midwest Center for Health Services and Policy Research, Hines VA Hospital, P.O. Box 5000 (151-H), Hines, IL 60141. E-mail: lee{at}research.hines.med.va.gov

Patients with chronic obstructive pulmonary disease (COPD) are frequently treated with inhaled corticosteroids (ICS). However, the impact of ICS use on fracture risk remains unclear in these patients. This nested case–control study examines the association between ICS use and nonvertebral fractures in Veterans Affairs patients with COPD. From a cohort of 40,157 patients with a COPD diagnosis between October 1, 1998 and September 30, 1999, and that used services in the preceding 12-month period but did not have a COPD diagnosis, 1,708 cases with nonvertebral fractures were identified and matched to 6,817 control patients. Patients were 94% male, and average age was 62.7 years. ICS exposure was identified through prescription records and converted to beclamethasone equivalents. In conditional logistic regression models, exposure to ICS at any time during follow-up was not associated with an increased fracture risk (adjusted odds ratio = 0.97; 95% confidence interval, 0.84–1.11). However, current high-dose ICS users (>= 700 µg per day) had an increased risk of fractures compared with patients with no exposure (adjusted odds ratio = 1.68; 95% confidence interval, 1.10–2.57). In patients with COPD, current use of high-dose ICS was associated with an increased risk of nonvertebral fractures.

Key Words: inhaled corticosteroids • pharmacoepidemiology • chronic obstructive pulmonary disease • nested case–control studies • fractures




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