Fractures in COPD Patients Linked to Inhaled Corticosteroids

COPD patients are at increased risk of fracture when using inhaled-corticosteroids

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Women in menopause are more likely to have bone fractures than men. A recent medical review indicates that older men with chronic obstructive pulmonary disease (COPD) who use inhaled-corticosteroids can join women with the bone fracture risk.

A new Johns Hopkins study indicates that patients with chronic obstructive pulmonary disease (COPD) who are on a course of inhaled corticosteroids for longer than six months have a 27 percent increased risk of bone fractures.

"Ask your doctor if inhaled corticosteroids are appropriate for you."

Sonal Singh, M.D., M.P.H., an assistant professor of general internal medicine at the Johns Hopkins University School of Medicine and the senior author of this study reports that there are millions of COPD patients who use long-term inhaled corticosteroids in the United States and around the world, so the numbers are fairly staggering of people who are getting fractures because of this medication use.

Dr. Singh advocates for patient education in terms of the risk/benefit ratio. Additionally, those who continue using inhaled corticosteroids should monitor their bone health and try to use the lowest dose available for the shortest duration of time possible. Patients with COPD are already at high risk for osteoporosis and fractures which may start from their nutritional challenges.

One treatment alternative which Singh surmises will help is the use of bone density drugs.

This study had Dr. Singh and his colleagues reviewing and analyzing two research studies which compared inhaled corticosteroids to a placebo in COPD patients. One study included 16 long-term double-blind randomized controlled trials with more than 17,500 participants; the other included seven observational studies with 69,000 participants.

In both groups of studies, the researchers found those patients using inhaled corticosteroids had a significant increase risk of fractures. The observational studies also noticed a trend upward for increasing risk of fracture as the dosage of the patient was increased. In other words, the higher the dose of medication used, the higher incidence of fractures.

One surprising  finding of the study was the increased risk of fractures in this study where 66 percent of the patients observed were men over 60 years old.

The researchers are wondering now about the population of women who are using inhaled corticosteroids as they are already at greater risk to develop osteoporosis than men.

Recent research has also linked other medications to fracture increase including some diabetes drugs like pioglitazone (Actos) and rosiglitazone (Avandia) and the class of heartburn drugs called proton pump inhibitors.

Dr. Singh advises the U.S. Food and Drug Administration should examine these findings.

This observational study was published online in the journal Thorax.

Reviewed by: 
Review Date: 
June 23, 2011
Last Updated:
June 28, 2011