Inhaled Corticosteroids and Fracture Risk: A Bad Break?

Feb 28, 2018

How much of a threat do these commonly prescribed agents pose to bone health?

References1. Gonzalez A, Coulombe J, Ernst P, et al. Long-term use of inhaled corticosteroids in COPD and the risk of fracture. Chest. 2018;153:321-328.2. Gray N, Howard A, Zhu J, et al. Association between inhaled corticosteroid use and bone fracture in children with asthma. JAMA Pediatr. 2018;172:57-64.

Two recent studies focus on the effects of the long-term use of inhaled corticosteroids on bone health and fracture risk in adults and children.^1,2 Scroll through the slides for the latest findings and take-home messages.
(Man with inhaler: ©Ljupco Smokovski/Shutterstock.com; boy with inhaler: ©wavebreakmedia/Shutterstock.com)

Inhaled corticosteroids are commonly used to treat obstructive pulmonary conditions, including asthma in adults and children. It is known that long-term use of systemic oral corticosteroids leads to poor bone formation and increased risk of bone fractures, especially in older patients and women. However, it is not well described how the long-term use of inhaled corticosteroids affects bone health and the risk of fractures in adults and children.

The study looked at a cohort of 240,110 subjects, of whom 19,396 sustained a fracture during a mean 5.3 years (rate, 15.2 per 1000 subjects per year).¹ There was a small increase in the risk of hip and upper extremity bone fracture only in adults who use inhaled corticosteroids for COPD for more than 4 years at doses above 1000 µg fluticasone equivalents. The risk was no different for men or women.

Take-home message: The long-term use of inhaled corticosteroids at high doses is associated with a modest but significant increase in the risk of fractures of the hip and upper extremity.
(©Ljupco Smokovski/Shutterstock.com)

Included in the study were 19,240 children aged 2 to 18 years with asthma. The results did not show a significant association between first fracture after asthma diagnosis and current use (odds ratio [OR], 1.07; 95% CI, 0.97-1.17), recent use (OR, 0.96; 95% CI, 0.86-1.07), or past use (OR, 1.00; 95% CI, 0.91-1.11) of inhaled corticosteroids, compared with no use.² The use of systemic corticosteroids in the 1-year look-back period resulted in greater odds of fracture (OR, 1.17; 95% CI, 1.04-1.33).

Take-home message: There is no association between past or present use of inhaled corticosteroids and risk of bone fracture in children with asthma.
(©wavebreakmedia/Shutterstock.com)