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Published ahead of print on January 7, 2004, doi:10.1164/rccm.200307-926OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 7, April 2004, 855-859

A more recent version of this article appeared on April 1, 2004
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Submitted on July 9, 2003
Accepted on January 5, 2004

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

Todd A Lee1* and Kevin B Weiss2

1 Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, IL, USA; Medicine and the Center for Healthcare Studies, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Pharmacy Practice, University of Illinois at Chicago, College of Pharmacy, Chicago, IL, USA, 2 Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, IL, USA; Medicine and the Center for Healthcare Studies, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

* To whom correspondence should be addressed. E-mail: lee{at}research.hines.med.va.gov.

Patients with COPD are frequently treated with inhaled corticosteroids. However, the impact of inhaled corticosteroid use on fracture risk remains unclear in these patients. This nested case-control study examines the association between inhaled corticosteroid use and non-vertebral 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, 1708 cases with non-vertebral fractures were identified and matched to 6817 controls. Patients were 94% male and average age was 62.7 years. Inhaled corticosteroid exposure was identified through prescription records and converted to beclamethasone equivalents. In conditional logistic regression models, exposure to inhaled corticosteroids at any time during follow-up was not associated with an increased fracture risk (Adjusted Odds Ratio=0.97; 95% CI, 0.84 to 1.11). However, current high dose inhaled corticosteroid users (>=700 µg per day) had an increased risk of fractures compared to patients with no exposure (Adjusted Odds Ratio=1.68; 95% CI, 1.10 to 2.57). In patients with COPD, current use of high dose inhaled corticosteroids was associated with an increased risk of non-vertebral fractures.
Key words: inhaled corticosteroids, pharmacoepidemiology, chronic obstructive pulmonary disease, nested case-control studies, fractures




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