Fracture risk associated with inhaled corticosteroid use in chronic obstructive pulmonary disease

Todd A. Lee*, Kevin B. Weiss

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

87 Scopus citations


Patients with chronic obstructive pulmonary disease (COPD) are frequently treated with inhaled corticosteroids (ICS). However, the Impact of ICS use on fracture risk remains unclear in these patients. This nested case-control study examines the association between ICS use and nonvertebral fractures in Veterans Affairs patients with COPD. From a cohort of 40,157 patients with a COPD diagnosis between October 1, 1998 and September 30, 1999, and that used services in the preceding 12-month period but did not have a COPD diagnosis, 1,708 cases with nonvertebral fractures were identified and matched to 6,817 control patients. Patients were 94% male, and average age was 62.7 years. ICS exposure was identified through prescription records and converted to beclamethasone equivalents. In conditional logistic regression models, exposure to ICS at any time during follow-up was not associated with an increased fracture risk (adjusted odds ratio = 0.97; 95% confidence interval, 0.84-1.11). However, current high-dose ICS users (≥ 700 μg per day) had an increased risk of fractures compared with patients with no exposure (adjusted odds ratio = 1.68; 95% confidence interval, 1.10-2.57). In patients with COPD, current use of high-dose ICS was associated with an increased risk of nonvertebral fractures.

Original languageEnglish (US)
Pages (from-to)855-859
Number of pages5
JournalAmerican journal of respiratory and critical care medicine
Issue number7
StatePublished - Apr 1 2004


  • Chronic obstructive pulmonary disease
  • Fractures
  • Inhaled corticosteroids
  • Nested case-control studies
  • Pharmacoepidemiology

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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