LAUSR

Background: Data are lacking on long-term safety of inhaled corticosteroids (ICS) in COPD. Currently, ICS are recommended together with long-acting s2 agonists for patients with frequent COPD exacerbations despite optimal bronchodilator therapy. Objective: To evaluate whether ICS therapy for COPD is associated with increased onset of osteoporosis. Methods: Using de-identified medical record data (1990–2016) from two large UK general practice databases, we studied 19,898 patients aged ≥40 years when initiated on ICS or long-acting bronchodilators for COPD. Eligible patients had no prior asthma or osteoporosis diagnosis/therapy, ≥1-year baseline and ≥1.5-year outcome data. After mixed matching (1:1–3:1 ratios) using direct matching and propensity scores, treatment cohorts were compared using conditional proportional hazards regression, adjusting for residual confounding. Results: 61% in 2016 GOLD A+B and 64% in GOLD C+D were prescribed ICS. New osteoporosis diagnoses were 0.70 vs. 0.66 per 100 patient-years in matched ICS and non-ICS cohorts, respectively, during median follow-up time of 5 years and 4 years, respectively. Risk of osteoporosis was numerically greater (+13%, p=0.22) in the ICS-treated patients overall and showed a dose response, with significant increases in risk of 47–342% at higher doses (Table). Conclusions: Long-term, high-dose ICS therapy for COPD is associated with an increased risk of osteoporosis.