SOURCE: Gonzalez AV, et al. Chest 2018;153:321-328.

Clinicians have long been reassured by reports about the safety of inhaled corticosteroids (ICS) in asthma, which assert no long-term increased fracture risk, albeit a measurable decrement in bone mineral density (BMD) may be seen. On the other hand, most of the asthmatic population is comprised of younger patients who are not near the peak age of fracture risk. The potential consequences of ICS might be better demonstrated in persons with COPD, who are typically older than the asthma population. In addition, COPD itself is a risk factor for osteoporosis, as is cigarette smoking.

Using the large database of the Quebec healthcare system, fracture rates were assessed in a cohort of 240,110 subjects. Over a five-year follow-up period, more than 19,000 fractures occurred. The mean age of patients with a fracture and the comparison control group was 75 years. Use of ICS for more than four years at a dose of ≥ 1,000 fluticasone equivalents/day was associated with a small but statistically significant 10% increase in relative risk (RR) for hip or upper extremity fracture (RR, 1.10; 95% confidence interval, 1.02-1.19). There did not appear to be any differential risk between men and women. Clinicians should strive to use the minimum ICS necessary to achieve symptomatic improvements in COPD patients.