Fracture Risk in Patients With Chronic Lung Diseases Treated With Bronchodilator Drugs and Inhaled and Oral Corticosteroids

BackgroundChronic lung diseases and drugs used to treat patients with chronic lung diseases may be associated with an increased fracture risk.MethodsThe design was a case-control study of all patients with a fracture (n = 124,655) in the year 2000 in Denmark as case subjects. For each case subject, three age- and gender-matched control subjects were randomly drawn from the general population (n = 373,962).ResultsChronic lung diseases such as COPD (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.13 to 1.25), emphysema (OR, 1.31; 95% CI, 1.16 to 1.48), and other chronic lung diseases (OR, 1.20; 95% CI, 1.00 to 1.44) were associated with a higher relative risk of any fracture than asthma (OR, 1.06; 95% CI, 1.01 to 1.12). Oral corticosteroids were associated with a dose-dependent increased risk of fractures. Inhaled short-acting β-agonists were associated with an increase in fracture risk that was not dose dependent and was seen already at low doses. Oral β-agonists were associated with an increase in fracture risk at low doses but not at higher doses. Other bronchodilators (inhaled long-acting β-agonists, inhaled β-agonists plus inhaled corticosteroids, inhaled β-agonists plus antimuscarinic substances, inhaled antimuscarinic substances, inhaled cromoglycate and cromoglycate-like substances, oral theophylline, and oral leukotriene receptor antagonists), and inhaled corticosteroids were not associated with fracture risk.ConclusionsThe increase in fracture risk seen with inhaled short-acting β-agonists may be linked to the severity of the underlying lung disease rather than with the β-agonists, per se, as other types of β-agonists were not associated with fractures.