Steroid puffs do not up nonvertebral fracture risk

In the short term, the risk of nonvertebral fracture is not increased in older adults with asthma or chronic obstructive pulmonary disease (COPD) who use inhaled corticosteroids (ICS), a study shows.

"Concern about nonvertebral fracture risk should not strongly influence the decision to use recommended doses of ICS for adults patients with asthma or COPD," study authors write in the journal Chest.

In the study, researchers examined the risk of nonvertebral fracture in 89,877 adults who filed insurance claims for asthma and/or COPD.

Overall, 1722 patients were treated for a nonvertebral fracture, with the insurance claim of the first fracture designed as the index date. A total of 17,220 controls were randomly selected and assigned a random index date.

Dr. Catherine B. Johannes, of Ingenix Epidemiology in Auburndale, Massachusetts, and colleagues documented ICS exposure 1 month, 3 months, 6 months, and 1 year before the index date. Estimated cumulative doses at various time periods were ascertained.

Roughly 35 percent of the study population was exposed to ICS - 15 percent were exposed to fluticasone propionate and 22 percent were exposed to other ICS - and 27 percent had exposure to oral corticosteroids in the year before the index date.

After taking into account potentially confounding factors, "no increased fracture risk with ICS exposure as a class or with fluticasone propionate alone was detected," they researchers report.

They emphasize, however, that this study did not evaluate the risks associated with exposure to very-high doses of ICS or very long-term use of ICS, or the risk of vertebral fractures.

SOURCE: Chest, January 2005.