Inhaled corticosteroids and fractures in chronic obstructive pulmonary disease: current understanding and recommendations.

PURPOSE OF REVIEW: Inhaled corticosteroid (ICS) is commonly used in the management of patients with chronic obstructive pulmonary disease (COPD) for symptom relief and exacerbation prevention; however, there is a growing concern that ICS increases risk of osteoporosis and fractures in patients with COPD.

RECENT FINDINGS: Osteoporosis is a major comorbidity of COPD. There is evidence from large observational studies that use of ICS for prolonged period of time (e.g. ≥4 years) is associated with accelerated loss of bone mineral density and increased risk of fractures in a dose-dependent and time-dependent fashion in patients with COPD. The risk of fractures appears increase significantly when high doses of ICS (at least 250 μg/day in fluticasone or equivalents) are used for a long period of time (at least 3 years).

SUMMARY: ICS increases risk of bone demineralization and fracture in patients with COPD. It should be generally avoided in patients with previous fractures or significant osteoporosis. If they are used in such patients, close monitoring is recommended for accelerated bone demineralization.