Glucocorticoids Do Not Increase Fracture Risk in COPD

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Prophylactic treatment of fractures may not be essential for patients with COPD who are receiving an intermittent dose of glucocorticoids.
Prophylactic treatment of fractures may not be essential for patients with COPD who are receiving an intermittent dose of glucocorticoids.

Intermittent use of high-dose glucocorticoids did not increase the risk for any, osteoporotic, hip, or clinically symptomatic vertebral fractures in patients with chronic obstructive pulmonary disease (COPD), according to the results of a case-control study published in Bone.

Olorunfemi A. Oshagbemi, MPH, PhD, from the Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands, and colleagues used Danish National Hospital Discharge Registry data collected between January 1996 and December 2011 and conditional logistics regression models to derive adjusted odds ratios (OR) for fractures in patients with COPD stratified by intermittent use of high-dose glucocorticoids and proxies of disease severity.

The investigators identified 635,536 patients and an equal number of controls. The adjusted OR for any, osteoporotic, hip, or clinical symptomatic vertebral fracture for patients with COPD and intermittent use of high average daily dose oral glucocorticoids was 0.65, 0.70, 1.17, and 1.98, respectively, compared with individuals who did not have COPD. However, the authors did identify an elevated risk for osteoporotic fracture in patients who visited the emergency department (adjusted OR, 1.47) or were hospitalized in the previous year for COPD (adjusted OR 1.76).

Furthermore, current glucocorticoid use in patients with COPD was associated with an increased risk for osteoporotic hip and clinically symptomatic vertebral fractures compared with individuals without COPD.

The authors concluded that prophylactic treatment of fractures may not be essential for patients with COPD who are receiving an intermittent dose of glucocorticoids. However, for patients who are on long-term high-doses of glucocorticoids and men or postmenopausal women older than 40 years or those who have advanced COPD, prophylaxis should be considered. 

Because this was an observational study, the investigators could not rule out the possibility of misclassification of exposure to glucocorticoids, and they also lacked information on the severity of COPD.

Reference

Oshagbemi OA, Burden AM, Shudofsky KM, et al. Use of high-dose intermittent systemic glucocorticoids and the risk of fracture in patients with chronic obstructive pulmonary disease. Bone. 2018;110:238-243.

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