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- Original Article Elevated Fracture Risks in Patients Using Inhaled Corticosteroids: A Korean Nationwide Study
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Sung Hye Kong1,2*
, Ae Jeong Jo3*
, Chan Mi Park4, Kyun Ik Park4, Ji Eun Yun4
, Jung Hee Kim2,5
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DOI: https://doi.org/10.3803/EnM.2024.1990 [Epub ahead of print]
Published online: August 30, 2024
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2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
3Department of Data Science, Andong National University, Andong, Korea
4National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul, Korea
5Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Corresponding author:
Ji Eun Yun, Tel: +82-2-2174-2754, Fax: +82-2-741-7160,
Email: jeyun@neca.re.kr
Jung Hee Kim, Tel: +82-2-2072-4839, Fax: +82-2-2072-4839,
Email: jhee1@snu.ac.kr
*These authors contributed equally to this work.
contributed equally to this study as co-first authors.
Abstract
Background
In this comprehensive retrospective nationwide cohort study, we examined the relationships between various asthma medications and bone health, utilizing data from the National Health Insurance Service database of South Korea.
Methods
From 2015 to 2019, the relevant dataset included 168,611 individuals aged 66 years, among whom 8,747 were diagnosed with asthma. We focused on a subset of 6,173 patients, all 66-year-old women. Participants were categorized into four groups: nonusers of asthma medication (n=2,868), leukotriene antagonist users (n=2,281), inhaled corticosteroid (ICS) users (n=517), and those using a combination of ICS and long-acting beta-agonist (ICS+LABA) medication (n=507). The primary outcomes measured were the incidences of major osteoporotic fractures and hip fractures during the follow-up period.
Results
Over 2.7 years of follow-up, 615 cases of major osteoporotic fractures and 96 cases of hip fractures were recorded. ICS users exhibited a heightened risk of both injuries, with hazard ratios of 1.38 (95% confidence interval [CI], 1.18 to 1.63; P<0.001) for major osteoporotic fractures and 1.56 (95% CI, 1.33 to 1.83; P<0.001) for hip fractures. Similarly elevated risks were observed in the ICS+LABA group. Notably, the risk associated with ICS was particularly pronounced among patients with osteopenia for both fracture types. Overall, the use of ICS, alone or in combination with LABA, in patients with asthma is associated with significantly increased risks of osteoporotic fractures, especially among those with osteopenia.
Conclusion
These findings underscore the importance of considering bone health when managing asthma, especially in older patients and those with existing bone density issues.
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