Severity of obstructive airway disease and risk of osteoporotic fracture

Abstract

The use of inhaled corticosteroids has been associated with a dose-related increased risk of fracture. This may be related to systemic absorption. However, several studies have found that patients with more severe reductions in pulmonary function had reduced bone mineral density, independent of inhaled corticosteroids. The objective of this study was to evaluate the relationship between disease severity and fracture risk.A large case-control study (108,754 cases) was conducted using data from the UK General Practice Research Database. It was found that higher doses of inhaled corticosteroids were associated with greater risks of fracture. The crude odds ratio of fracture among patients exposed to .1,600 mg beclomethasone equivalents per day was 1.95 (95% confidence interval (CI) 1.68-2.27). When adjustments were made for disease severity and use of bronchodilators, the initial dose-response relationship between inhaled corticosteroids and fracture risk disappeared (adjusted odds ratio of 1.19 (95% CI 1.01-1.41)).In conclusion, patients with severe obstructive airway disease are at risk of fracture. However, adequate adjustment for disease severity is essential when the association between the use of inhaled corticosteroids and risk of osteoporotic fracture is studied in observational research.

Is lung function associated with bone mineral density? Results from the Hertfordshire Cohort Study

“…COPD and bronchial asthma are risk factors for osteoporosis; these patients often display a loss of significant amounts of both cortical and trabecular bone [1][2][3][4][5][6][7][8][9]. These patients are also often treated with oral or inhaled glucocorticoids and this contributes to significant additional bone loss.…”

Review: Systemic consequences of COPD

“…The risk is amplified in patients who are thin (BMI <20 kg/m 2 ; RR, 2.54) and in those who experience exacerbations (RR, 2.02). COPD patients are particularly vulnerable to vertebral fractures [de Vries et al 2005]. Their risk is increased four to eight fold above those without COPD.…”

Tratamento farmacológico da DPOC

“…Most of the adverse drug effects reported in the studies included in the present review were not severe; nevertheless, some analyses showed arrhythmias, (73) cardiac ischemic events, (74) and fractures. (75)(76)(77) Of those analyses, 21 showed that the adverse effects of COPD medications were worse than were those of placebo. Only 3 analyses-2 involving the use of LAMAs (35) and 1 involving the use of ICs (78) -showed that the medications had fewer adverse effects than did placebo.…”

“…It is possible that the large loss to follow-up among the controls compromised the results and made it difficult to detect that benefit among the patients who received treatment. Two recent meta-analyses compared various therapeutic fracture, (76,77,80) except in one study. (75) However, the use of systemic corticosteroids has been shown to increase that risk.…”