Use of high-dose intermittent glucocorticoids and the risk of fracture in patients with COPD

OBJECTIVE To investigate the effects of high-dose intermittent glucocorticoid IGC) use on fracture risk in patients with chronic obstructive pulmonary disease [COPD]. DESIGN Population-based retrospective case-control study. METHODS We conducted this study using data from the Danish National Databases. Cases were subjects 2 45 years with COPD, who sustained an osteoporotic fracture during the study period (1996-2011). To each case, a control without a fracture was matched by gender and year of birth. Also oral glucocorticoid use was evaluated before the index date. Associations between glucocorticoid use and fracture risk were determined using conditional logistic regression. Adjustments were made for comorbidities, drug use and disease severity. RESULTS Fracture risk in COPD patients currently using high-dose intermittent glucocorticoids was not increased (corrected odds ratio (0Rcorr)0.70; 95% confidence interval [CI95] 0.49- 0.99). GC users with average daily dose a 15 mg and cumulative dose a 1 g did have a significantly increased fracture risk (ORcorr 1.34, CI95 1.09-1.64). Stratification of current GC use to average daily dose did not show a clear dose-effect relationship (<7.5 mg: ORcorr 1.08, CI95 0.99-1.17; 7.5-14.9 mg: 0Rcorr 1.20, CI95 1.07-1.34; a 15 mg: ORcorr 1.15, CI95 0.96-1.37). For cumulative dose a trend was seen (cumulative dose s 5 g: 0Rcorr 1.15. CI95 1.02-1.31). CONCLUSION COPD patients using high-dose intermittent glucocorticoids do not have an increased risk of osteoporotic fractures, regardless of disease severity. On the contrary, long-Term heavy users have a clear fracture risk which is in line with guideline recommendations on fracture prevention.