Inhaled Corticosteroids Raise Fracture Risk in COPD Patients

Patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) often are treated with inhaled corticosteroids (ICS) to decrease the frequency of exacerbations. Systemic absorption clearly occurs at high doses, but whether such absorption results in lower bone density and elevated fracture risk remains unclear.

A meta-analysis of 16 randomized controlled trials (RCTs) involved 9143 ICS users and 8370 controls; fluticasone or budesonide were used in all but one of the RCTs. Most patients had severe COPD, and older men predominated. All studies included long-term follow-up (mean duration, 90 weeks), but individual studies varied widely. Fracture risk rose significantly with ICS use — 180 fractures occurred in ICS recipients, and …