Inhaled steroids and prevalence of osteoporosis in chronic obstructive pulmonary disease: Data from the DACCORD cohort

Introduction: Osteoporosis is a frequent COPD comorbidity with age, female gender, smoking, immobility and the use of oral steroids (OCS) as common risk factors. The role of inhaled steroids (ICS) is still under debate. Methods: Baseline data from the real life cohort DACCORD were analyzed. The diagnosis of osteoporosis was based on patients' reports of physician-based diagnoses. Associations of ICS exposure at time of inclusion and osteoporosis were examined by group comparisons and multivariable logistic regression analyses with age, gender, smoking, exacerbation history (EH) and FEV1% as covariates. To avoid interactions with other steroid containing medications, exposure to any corticosteroids (CS), no steroid exposure and exposure to ICS only were considered separately. Results: 6611 patients (41 % female), were included. Osteoporosis was diagnosed in 412 (6%) patients of which 73% were female. 41% of patients received ICS at study inclusion, whereby the majority (72%) were free from exacerbations during the previous 6 months. A higher proportion of patients with osteoporosis were treated with ICS (46% vs 39%; p=0.006) or OCS (9% vs 3%; p<0.001) compared to the patients without osteoporosis. Adjusted ORs were significant for female gender (OR, 4.77; p<0.001), BMI (OR, 0.97; p=0.008), age (OR, 1.07; p<0.001), EH (OR, 1.34; p=0.011), exposure to any CS (OR, 3.52; p<0.001) as well as ICS only (OR, 1.43; p<0.001). No associations were observed with FEV1% or smoking status. Conclusion: Exposure to ICS was associated with an increased risk of osteoporosis. The risk of osteoporosis needs consideration when assessing risks and benefits of ICS therapy in COPD.