Inhaled Corticosteroids and Risk of Osteoporosis in Late-Middle Age Subjects: A Multicenter European Cohort Study

Background: inhaled corticosteroids (ICS) have been widely used for the regular treatment of asthma and chronic obstructive pulmonary diseases (COPD) over the past few decades. To date, studies investigating the effects of ICS on bone in populations including asthma and COPD patients, show conflicting results. The skeletal effects of ICS remain poorly understood. Aims: to assess the association between ICS exposure and self-reported osteoporosis diagnosis in a European cohort study. Methods: the analysis was carried out by using clinical and questionnaire data available for subjects participating in the ECRHS III (European Community Respiratory Health Survey) with age >55 years. Results: among 3004 enrolled subjects, 245 were ICS users with an exposure > 12 months. Osteoporosis was reported by 16 subjects in the ICS group (6.5%) and by 167 in the not exposed group (6.1%). The adjusted risk of osteoporosis in ICS users (>12 months) was not different when compared with not exposed subjects (OR=1.02, 95CI%: 0.51, 2.03). The same result was observed even when the analysis considered a longer exposure to the ICS use (> 36.5 months, the median ICS exposure for all subjects). History of COPD, use of OCS, BMI (Body Mass Index), smoking and physical activity were not risk factors for osteoporosis. Conclusions: our study did not show any significant association between long- term ICS use and self-reported diagnosis of osteoporosis in subjects aged >55 years. To explore the real effect of ICS on bone status, further controlled studies are needed, especially in the long-term ICS exposure.