Using Taiwan NHIRD for studying the effect of inhaled corticosteroids on fracture

Inhaled corticosteroid is a popular treatment for chronic respiratory diseases. Its side effects include decreased bone mineral density and osteoporosis. The aim of this study is to investigate the association of inhaled corticosteroids and fracture. The data of the patients who were 20 years old or older visiting healthcare centers (outpatients or inpatients) and had been prescribed with inhale corticosteroids within 2002–2010 were retrieved from the National Health Insurance Research Database (NHIRD) for this investigation. Patients diagnosed with hip fracture or vertebrate fractures before using inhaled corticosteroid were excluded. A Total of 11645 patients receiving inhaled corticosteroid therapy were included in this study; among them, 1134 (9.7%) with either hip fracture or vertebrate fracture were observed. The average cumulated inhaled corticosteroid for patients with fracture (230.14±442.76 mg) was significantly higher (p<0.001) than those without fracture (171.97±318.13 mg). Based on the analytical results, it was observed that long-term use of inhaled corticosteroids may induce osteoporosis and exhibit higher incidence of hip or vertebrate fractures.

[1]  L. Forsén,et al.  Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trøndelag Health Survey , 1999, Diabetologia.

[2]  J. Elborn,et al.  COPD–bronchiectasis overlap syndrome , 2015, European Respiratory Journal.

[3]  Kayleigh Kew,et al.  Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease. , 2014, The Cochrane database of systematic reviews.

[4]  M. Martínez-García,et al.  Bronchiectasis Phenotype in COPD Patients , 2015 .

[5]  R. Cavallazzi,et al.  Risk of fractures with inhaled corticosteroids in COPD: systematic review and meta-analysis of randomised controlled trials and observational studies , 2011, Thorax.

[6]  R. Hubbard,et al.  Inhaled corticosteroids and the risk of pneumonia in people with asthma: a case-control study. , 2013, Chest.

[7]  P. Vestergaard,et al.  Fracture risk in patients with chronic lung diseases treated with bronchodilator drugs and inhaled and oral corticosteroids. , 2007, Chest.

[8]  R. Hubbard,et al.  Inhaled corticosteroids and the risk of fracture in chronic obstructive pulmonary disease. , 2007, QJM : monthly journal of the Association of Physicians.

[9]  Ji‐Hyun Lee,et al.  Inhaled corticosteroid is associated with an increased risk of TB in patients with COPD. , 2013, Chest.

[10]  Craig S. Wong,et al.  Increased risk of hip fracture among patients with end-stage renal disease. , 2000, Kidney international.

[11]  Alan D. Lopez,et al.  A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[12]  R. Lockey,et al.  Osteoporosis in the at‐risk asthmatic , 2014, Allergy.

[13]  Yung-fu Chen,et al.  Gout and a Subsequent Increased Risk of Erectile Dysfunction in Men Aged 64 and Under: A Nationwide Cohort Study in Taiwan , 2015, The Journal of Rheumatology.

[14]  M. V. Van Natta,et al.  Effect of inhaled glucocorticoids in childhood on adult height. , 2012, The New England journal of medicine.

[15]  Y. Loke,et al.  Bone mineral density and fracture risk with long-term use of inhaled corticosteroids in patients with asthma: systematic review and meta-analysis , 2015, BMJ Open.

[16]  Thomas Ferkol,et al.  The global burden of respiratory disease. , 2014, Annals of the American Thoracic Society.

[17]  T. Liou,et al.  Chronic Obstructive Pulmonary Disease Increases the Risk of Hip Fracture: A Nationwide Population-Based Cohort Study , 2016, Scientific Reports.

[18]  Edwin K Silverman,et al.  Reduced Bone Density and Vertebral Fractures in Smokers. Men and COPD Patients at Increased Risk. , 2015, Annals of the American Thoracic Society.

[19]  E. Stein,et al.  The Skeletal Effects of Inhaled Glucocorticoids , 2016, Current Osteoporosis Reports.

[20]  M. Abramson,et al.  Distinguishing adult-onset asthma from COPD: a review and a new approach , 2014, International journal of chronic obstructive pulmonary disease.

[21]  T. MacDonald,et al.  Quantifying the real life risk profile of inhaled corticosteroids in COPD by record linkage analysis , 2014, Respiratory Research.

[22]  Wei-Chih Liao,et al.  Chronic obstructive pulmonary disease and allied conditions is a strong independent risk factor for osteoporosis and pathologic fractures: a population-based cohort study. , 2015, QJM : monthly journal of the Association of Physicians.

[23]  P. Calverley,et al.  Use of inhaled corticosteroids in patients with COPD and the risk of TB and influenza: A systematic review and meta-analysis of randomized controlled trials. a systematic review and meta-analysis of randomized controlled trials. , 2014, Chest.

[24]  Craig S. Wong,et al.  Risk factors for hip fracture among patients with end-stage renal disease. , 2000, Kidney international.

[25]  R. Cumming,et al.  Diabetes and risk of fracture: The Blue Mountains Eye Study. , 2001, Diabetes care.

[26]  Bernadette A. Thomas,et al.  Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[27]  B. Heidari,et al.  Impact of treatment with inhaled corticosteroids on bone mineral density of patients with asthma: related with age , 2015, Osteoporosis International.

[28]  Shih-Feng Liu,et al.  Inhaled corticosteroids can reduce osteoporosis in female patients with COPD , 2016, International journal of chronic obstructive pulmonary disease.

[29]  D. Morrish,et al.  Prevalence of osteopenia and osteoporosis in patients with moderate to severe asthma in Western Canada. , 2015, Clinical and investigative medicine. Medecine clinique et experimentale.

[30]  Dirkje S Postma,et al.  The Asthma-COPD Overlap Syndrome. , 2015, The New England journal of medicine.