Intermittent use of high-dose glucocorticoids does not increase fracture risk in COPD patients
Intermittent high-dose glucocorticoids (GCs) therapy does not contribute to an increase in the risk of any, osteoporotic, hip or clinically symptomatic vertebral fractures in patients with chronic obstructive pulmonary disorder (COPD), according to a study. However, current GC use appears to increase the risk of hip and clinically symptomatic vertebral fractures.
Researchers conducted a case-control study involving 635,536 COPD patients and the same number of non-COPD controls (mean age 67.5 years; 65 percent female). Conditional logistics regression models were used to estimate the risk of fractures in COPD patients stratified by intermittent high-dose and proxies of disease severity (eg, hospitalisation and emergency visit for COPD in the past year).
Compared with non-COPD controls, COPD patients with intermittent use of high average daily dose oral GCs did not show an elevated risk of any fracture (adjusted odds ratio [aOR], 0.65; 95 percent CI, 0.50–0.86), osteoporotic fracture (aOR, 0.70; 0.70–0.99), hip fracture (aOR, 1.17; 0.59–2.32) or clinically symptomatic vertebral fracture (aOR, 1.98; 0.59–6.65).
On the other hand, the risk of osteoporotic fracture was heightened in patients who visited the emergency unit (aOR, 1.47; 1.20–1.79) or those who were hospitalized in the past year for COPD (aOR, 1.76; 1.66–1.85).
Current GC use among COPD patients vs non-COPD controls was associated with an increased risk of osteoporotic, hip and clinically symptomatic vertebral fractures.
The present data suggest that prophylactic treatment of fractures need not be emphasized in patients with COPD receiving intermittent dose of GCs, whereas it should be considered for high-dose long-term GC users with advanced COPD disease stage, postmenopausal women and men aged >40 years.