Montreal—While previous studies have suggested that long-term use of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) patients affects bone density, a new study takes it a step farther. Results suggest an increase in bone fractures.

The article in the journal CHEST indicates increased risk of the fractures in both men and women. The earlier research documented dose-dependent negative impact on bone mineral density, especially in postmenopausal women, but left effect on fractures as an open question.

For the study, researchers from McGill University and the Jewish General Hospital-Lady Davis Research Institute used a population-based cohort of patients with COPD, aged 55 years or older, in Quebec. Focusing on those with occurrence of a hip or upper- extremity fracture, the study team found that long-term ICS exposure at high doses was associated with a modest but significant increase in the risk of hip or upper-extremity fractures.

The study ran from 1990 to 2005, with patients followed until 2007. Of the 240,110 patients with COPD in the cohort, 19,396 sustained a fracture during a mean 5.3 years, for a rate of 15.2 per 1,000 per year. The fracture rate was increased for those who used ICS longer than 4 years at daily doses of 1,000 mcg or more, for a risk ratio of 1.10; 95% CI, 1.02-1.19. The risk did not differ for male and female COPD patients, study authors point out.

“Since fractures are more frequent in women than men, our study suggests that the excess number of fractures associated with ICS will be greater in women even though we did not find that the risk increase was particularly higher in women than in men,” explained lead research Samy Suissa, PhD. “Quantifying this excess number would require a larger cohort.”