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Inhaled Corticosteroids and the Risk of Fractures in Older Adults

A Systematic Review and Meta-Analysis

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Abstract

Background: Inhaled corticosteroids (ICS) are commonly prescribed medications for the management of asthma and chronic obstructive pulmonary disease. It is well established that long-term use of these drugs may lower bone mineral density. However, whether ICS increase the risk of fractures remains unknown. Recent studies that have attempted to explore this risk have had conflicting results. We sought to explore the risk of ICS and fractures among older adults by conducting a systematic review and meta-analysis of the literature.

Methods: We systematically searched several databases, including MEDLINE, EMBASE and the Cochrane Library, to identify pertinent studies.Those studies that potentially met our inclusion criteria were identified by two reviewers. Relative risks (RRs) were pooled using the random effects model. We also explored dose-response by stratifying the analysis on high and low doses of ICS. Heterogeneity was assessed using the Q statistic and publication bias was assessed using the funnel plot.

Results: Thirteen studies, including four randomized controlled trials, were included in the review. The pooled RRs for hip fractures and any fractures were 0.91 (95% CI 0.87, 0.96) and 1.02 (95% CI 0.96, 1.08), respectively. When we restricted the analysis to users of high-dose ICS, the pooled RRs for any fractures and hip fractures were 1.30 (95% CI 1.07, 1.58) and 1.32 (95% CI 0.90, 1.92), respectively. The funnel plot did not show evidence of publication bias.

Conclusion: We found no association between the use of ICS and fractures in older adults. A slight increase in risk was seen in those using high-dose ICS. The significance of this association should be investigated further.

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Acknowledgements

Dr Takkouche’s work in meta-analysis is funded by CIBER en Epidemiología y Salud Pública (CIBER-ESP), Spain. Dr FitzGerald has received fees for advisory board attendance and membership of Continuing Medical Education panels sponsored by a number of companies who market asthma-related drugs. In addition, he has received research funding for asthma-related research from a number of pharmaceutical companies that has been paid directly to the University of British Columbia. Dr FitzGerald is a recipient of the Michael Smith Foundation for Health Research Distinguished Scholar Award. The other authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver General Hospital, 7th Floor, 828 West 10th Ave, Vancouver, British Columbia, Canada

    Mahyar Etminan, Mohsen Sadatsafavi & Saeedreza Ganjizadeh Zavareh

  2. Department of Preventive Medicine, University of Santiago De Compostela, Santiago De Compostela, Spain

    Bahi Takkouche

  3. The Lung Centre, Vancouver General Hospital, Vancouver, British Columbia, Canada

    J. Mark FitzGerald

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  1. Mahyar Etminan
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  2. Mohsen Sadatsafavi
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  3. Saeedreza Ganjizadeh Zavareh
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  4. Bahi Takkouche
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  5. J. Mark FitzGerald
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Correspondence to Mahyar Etminan.

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Etminan, M., Sadatsafavi, M., Zavareh, S.G. et al. Inhaled Corticosteroids and the Risk of Fractures in Older Adults. Drug-Safety 31, 409–414 (2008). https://doi.org/10.2165/00002018-200831050-00005

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