- Steroid inhalers increase fracture risk in COPD

Steroid inhalers increase fracture risk in COPD

Posted Monday 26 September 2011 - 20:27 PM by David Chan

If the patient istaking any drugs with code atc:R01AD05 (Budesonide), atc:R01AD08 (Fluticasone), (Note: All COPD) then consider the following:

Recommendation: Previous studies have been mixed regarding the effect of inhaled corticosteroids like budesonide and fluticasone on bone density, and individual trials have been underpowered to look at the patient-oriented outcome of fractures. These authors did a careful search to identify all randomized trials and observational studies comparing a group of patients with COPD who received a corticosteroid with a group of similar patients who did not. This included placebo-controlled studies, and studies where both groups also received another drug, such as a long-acting beta agonist. The authors identified 16 randomized controlled trials (RCTs) with 17,513 patients, as well as 7 large cross-sectional or nested case-control studies with approximately 69,000 patients. The RCTs ranged from 24 weeks to 156 weeks in duration, with patient age means in the 60s. Allocation concealment and randomization methodology were adequate for approximately half the studies and unclear in the rest. A single large 3-year clinical trial with 3088 patients dominated the results, accounting for a majority of fractures. The relative risk for any fracture was 1.27 in the RCTs, with a 95% confidence interval from 1.01 to 1.58, and a number needed to treat to harm of 83 over 3 years. The observational studies found similar results (relative risk = 1.21 - 1.27, depending on the subgroup).

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Strength: Recommendation
Text: Previous studies have been mixed regarding the effect of inhaled corticosteroids like budesonide and fluticasone on bone density, and individual trials have been underpowered to look at the patient-oriented outcome of fractures. these authors did a careful search to identify all randomized trials and observational studies comparing a group of patients with copd who received a corticosteroid with a group of similar patients who did not. this included placebo-controlled studies, and studies where both groups also received another drug, such as a long-acting beta agonist. the authors identified 16 randomized controlled trials (rcts) with 17,513 patients, as well as 7 large cross-sectional or nested case-control studies with approximately 69,000 patients. the rcts ranged from 24 weeks to 156 weeks in duration, with patient age means in the 60s. allocation concealment and randomization methodology were adequate for approximately half the studies and unclear in the rest. a single large 3-year clinical trial with 3088 patients dominated the results, accounting for a majority of fractures. the relative risk for any fracture was 1.27 in the rcts, with a 95% confidence interval from 1.01 to 1.58, and a number needed to treat to harm of 83 over 3 years. the observational studies found similar results (relative risk = 1.21 - 1.27, depending on the subgroup).