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Deborah Leader, RN

Long-Term Use of Steroids Increases Risk of Fracture in COPD

By June 25, 2011

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If you have COPD and use an inhaled corticosteroid, either alone or in combination with other drugs, you have a 27%  increased risk of bone fracture, according to a recent study by Johns Hopkins University.

The study looked mostly at men, aged 60 years and older, which raises a question about how corticosteroids affect women who are already at risk for bone fracture due to osteoporosis.

Sonal Singh, M.D., M.P.H., assistant professor of general internal medicine at the Johns Hopkins University School of Medicine and the senior author of the study had this to say:

"There are millions of COPD patients who use long-term inhaled corticosteroids in the United States and millions more across the world," says  published online in the journal Thorax. "The number of people who are getting fractures because of these medications is quite large."

The study reviewed multiple, previously published studies, one consisting of more than 17,500 participants, and seven more totally 69,000 participants.  The primary drugs studied were fluticasone, used in Advair, and budesonide, used in Symbicort. The effect was found to be dose-related, as participants on higher doses appeared to have a greater risk of  fracture than those on lower doses.

Dr. Signh says he is most concerned about women and has asked the FDA to look into recent issues found in this study. The implications for the FDA looking into this matter remain to be seen.

How can you improve your bone health? The following tips will help:

  • quit smoking
  • moderate alcohol
  • get enough calcium and Vitamin D
  • perform weight-bearing exercise, like walking, everyday
  • get your bone density tested

If you take corticosteroids for COPD, have you suffered from a bone fracture? Share your comments.

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Yoon K Loke, Rodrigo Cavallazzi,Sonal Singh. Risk of fractures with inhaled corticosteroids in COPD: systematic review and meta-analysis of randomised controlled trials and observational studies.
Thorax doi:10.1136/thx.2011.160028.

June 25, 2011 at 9:44 am
(1) Heather Smiles says:

I take them (advair) didn’t want to for a long while because of this but for me the benefits out weigh the risks…if I didn’t take it I couldn’t breath. Maybe a new drug will be invented someday that doesn’t effect our bodies bones

June 25, 2011 at 1:15 pm
(2) copd says:

You are right, discussing the benefits and the risks with your doctor before deciding to take a drug is very important. Thanks for sharing.

June 25, 2011 at 11:11 pm
(3) kookykathy says:

I have used Advair 500/50 for years with no ill effects. My doctor also schedules bone density tests off and on to keep a check on my bone density.

November 25, 2011 at 6:13 pm
(4) billymac says:

My son (23) taking pulmicort daily since about 11 has been diagnosed as having osteoporosis resulting from compression fracture of vertebrae. Also has been diagnosed as a coeliac ( although he never had any adverse reaction or illness due to gluten, and was only diagnosed based upon blood test and on fact that he has osteoporosis. Biospy from gastroscopy was said to be “equivocal for coeliac disease”). Has also been diagnosed as exhibiting high urinary calcium excretion! Doctor says pulmicort is not a factor, but I have great doubts! Don’t know where to turn. I would welcome any advice please.

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