The effects of inhaled corticosteroids (ICS) on fracture risk in older women with chronic respiratory diseases are not well established. Our results indicate long-term ICS use in this population does not increase the risk of major osteoporotic fracture. This finding further elucidates the long-term safety of ICS in older women.
Inhaled corticosteroids (ICS) are frequently used in older women with chronic respiratory diseases. There is insufficient evidence regarding the association between long-term ICS use and the risk of fragility fractures in this population.
We used linked Manitoba health administrative databases and the provincial bone mineral density (BMD) registry (1996–2013) to identify women ≥ 40 years of age with asthma and/or chronic obstructive pulmonary disease (COPD) within 3 years preceding the baseline BMD test. We followed them until the first major osteoporotic fracture or end of study, whichever came first. ICS use, stratified by exposure tertiles, was measured within the 12-month period following the baseline BMD test (by total days and quantity, primary outcome), and over the entire follow-up period (by medication possession ratio (MPR) and average annual dose, secondary outcome). The hazard ratio of fracture with ICS use was estimated using a Cox proportional hazards model, controlling for baseline determinants of fracture.
Of 6880 older women with asthma (38%) or COPD (62%), 810 (12%) experienced a major osteoporotic fracture over a mean follow-up of 7.7 years (SD = 3.9). ICS use at any tertile was not associated with an increased risk of fracture (dispensed days, p = 0.90; dispensed quantity, p = 0.67). Similarly, ICS use at any tertile during the entire follow-up period was not associated with an increased risk of fracture (MPR, p = 0.62; average annual dose, p = 0.58).
Our findings do not support an increased risk of major osteoporotic fracture in older women with chronic respiratory diseases due to long-term ICS use.
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The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Manitoba Population Research Data Repository under HIPC Project Number 2011/2012-31). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred. Data used in this study are from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba and were derived from data provided by Manitoba Health. This article has been reviewed and approved by the members of the Manitoba Bone Density Program. BCN wrote the first draft of the manuscript. WDL was responsible for conception, design, data access, and analysis. All authors critically revised the article for important intellectual content and gave final approval of the version to be published. WDL had full access to all the data in the study and takes the responsibility for the integrity of the data and the accuracy of the data analysis.
MS received salary support from the Canadian Institutes of Health Research and Michael Smith Foundation for Health Research.
The study was approved by the Human Research Ethics Board of the University of Manitoba.
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Ng, B., Leslie, W., Johnson, K. et al. Effects of long-term inhaled corticosteroid treatment on fragility fractures in older women: the Manitoba BMD registry study. Osteoporos Int 31, 1155–1162 (2020). https://doi.org/10.1007/s00198-020-05361-9
- Chronic obstructive pulmonary disease
- Inhaled corticosteroids