RT Journal Article
SR Electronic
T1 Osteoporosis and fracture risk associated with ICS use among Swedish COPD patients: the ARCTIC study
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2000515
DO 10.1183/13993003.00515-2020
A1 Christer Janson
A1 Karin Lisspers
A1 Björn Ställberg
A1 Gunnar Johansson
A1 Florian S. Gutzwiller
A1 Karen Mezzi
A1 Linda Mindeholm
A1 Bine Kjoeller Bjerregaard
A1 Leif Jorgensen
A1 Kjell Larsson
YR 2020
UL http://erj.ersjournals.com/content/early/2020/08/28/13993003.00515-2020.abstract
AB The effect of inhaled corticosteroids (ICS) on the risk of osteoporosis and fracture in patients with chronic obstructive pulmonary disease (COPD) remains uncertain. The aim of this study was to assess this risk in patients with COPD.Electronic medical record data linked to National Health Registries were collected from COPD patients and matched reference controls at 52 Swedish primary care centres (2000–2014). The outcomes analysed were the effect of ICS on all fractures, fractures typically related to osteoporosis, recorded osteoporosis diagnosis, prescriptions of drugs for osteoporosis and a combined measure of any-osteoporosis-related event. The COPD patients were stratified by the level of ICS exposure.A total of 9651 patients with COPD and 59 454 matched reference controls were analysed. During the follow-up, 19.9% of COPD patients had at least one osteoporosis-related event compared with 12.9% of reference controls (p<0.0001). Multivariate analysis in the COPD population demonstrated a dose-effect relationship, with high-dose ICS being significantly associated with any osteoporosis-related event (risk ratio [RR; 95% confidence interval] 1.52 [1.24–1.62]), while the corresponding estimate for low-dose ICS was 1.27 (1.13–1.56), compared with COPD patients not using ICS. A similar dose-related adverse effect was found for all four of the specific osteoporosis-related events: all fractures, fractures typically related to osteoporosis, prescriptions of drugs for osteoporosis and diagnosis of osteoporosis.We conclude that patients with COPD have a greater risk of bone fractures and osteoporosis and high-dose ICS use increased this risk further.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Janson reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from GlaxoSmithKline, personal fees from Novartis, personal fees from Teva, outside the submitted work.Conflict of interest: Dr. Lisspers reports personal fees from AstraZeneca, personal fees from Novartis, personal fees from Boehringer-Ingelheim, personal fees from Glaxo-Smith-Kline, personal fees from Chiesi, outside the submitted work.Conflict of interest: Dr. Ställberg reports personal fees from AstraZeneca, personal fees from Novartis, personal fees from Boehringer Ingelheim, personal fees from GlaxoSmithKleine, personal fees from Meda, personal fees from Teva, personal fees from Chiesi, outside the submitted work.Conflict of interest: Dr. Johansson has nothing to disclose.Conflict of interest: Dr. Gutzwiller is an employee of Novartis Pharma AGConflict of interest: Karen Mezzi is an employee of Novartis Pharma AGConflict of interest: Linda Mindeholm is a consultant to Novartis and shareholder of Novartis, Alcon and Novo-NordiskConflict of interest: Bine Kjoeller Bjerregaard is an employee of IQVIA, and received remuneration in relation to statistical analyses.Conflict of interest: Dr. Jörgensen reports other from IQVIA, outside the submitted work.Conflict of interest: Kjell Larsson has, during the last 5 years, on one or more occasion served in an advisory board, served as a speaker and/or participated in education activities arranged by AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Takeda, Novartis, Chiesi, Orion and Teva.