Summary

The effects of inhaled corticosteroids (ICS) on fracture risk in older women with chronic respiratory diseases are not well established. Our results indicate long-term ICS use in this population does not increase the risk of major osteoporotic fracture. This finding further elucidates the long-term safety of ICS in older women.

Introduction

Inhaled corticosteroids (ICS) are frequently used in older women with chronic respiratory diseases. There is insufficient evidence regarding the association between long-term ICS use and the risk of fragility fractures in this population.

Methods

We used linked Manitoba health administrative databases and the provincial bone mineral density (BMD) registry (1996–2013) to identify women ≥ 40 years of age with asthma and/or chronic obstructive pulmonary disease (COPD) within 3 years preceding the baseline BMD test. We followed them until the first major osteoporotic fracture or end of study, whichever came first. ICS use, stratified by exposure tertiles, was measured within the 12-month period following the baseline BMD test (by total days and quantity, primary outcome), and over the entire follow-up period (by medication possession ratio (MPR) and average annual dose, secondary outcome). The hazard ratio of fracture with ICS use was estimated using a Cox proportional hazards model, controlling for baseline determinants of fracture.

Results

Of 6880 older women with asthma (38%) or COPD (62%), 810 (12%) experienced a major osteoporotic fracture over a mean follow-up of 7.7 years (SD = 3.9). ICS use at any tertile was not associated with an increased risk of fracture (dispensed days, p = 0.90; dispensed quantity, p = 0.67). Similarly, ICS use at any tertile during the entire follow-up period was not associated with an increased risk of fracture (MPR, p = 0.62; average annual dose, p = 0.58).

Conclusion

Our findings do not support an increased risk of major osteoporotic fracture in older women with chronic respiratory diseases due to long-term ICS use.

中文翻译：

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长期吸入糖皮质激素治疗对老年女性脆性骨折的影响：曼尼托巴省BMD登记研究

概要

吸入性糖皮质激素（ICS）对患有慢性呼吸系统疾病的老年妇女骨折风险的影响尚不明确。我们的结果表明，在该人群中长期使用ICS不会增加发生严重骨质疏松性骨折的风险。这一发现进一步阐明了ICS在老年妇女中的长期安全性。

介绍

吸入性糖皮质激素（ICS）常用于患有慢性呼吸系统疾病的老年妇女。没有足够的证据表明长期使用ICS与该人群的脆性骨折风险之间存在关联。

方法

我们使用链接的曼尼托巴卫生管理数据库和省骨密度（BMD）注册中心（1996-2013），在基线BMD测试之前的3年内确定≥40岁的哮喘和/或慢性阻塞性肺疾病（COPD）妇女。我们一直跟踪他们，直到出现第一个主要的骨质疏松性骨折或研究结束为止，以先到者为准。在基线BMD测试后的12个月内（通过总天数和数量，主要结局）以及整个随访期内（通过药物拥有率（MPR）和平均年剂量，次要结果）。使用Cox比例风险模型估算ICS使用骨折的危险比，并控制骨折的基线决定因素。

结果

在6880名患有哮喘（38％）或COPD（62％）的老年妇女中，有810名（12％）在平均7.7年的随访中经历了严重的骨质疏松性骨折（SD = 3.9）。在任何三分位数中使用ICS都不会增加骨折的风险（分配天数，p  = 0.90；分配量，p  = 0.67）。同样，在整个随访期间，任何三分位数的ICS使用均与骨折风险增加无关（MPR，p  = 0.62；年平均剂量，p  = 0.58）。

结论

我们的发现不支持由于长期使用ICS而导致患有慢性呼吸系统疾病的老年妇女发生严重骨质疏松性骨折的风险增加。