Evaluating the association of osteoporosis with inhaled corticosteroid use in chronic obstructive pulmonary disease in Taiwan.

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and osteoporosis is the major comorbidity associated with poor prognosis in COPD. However, the effect of inhaled corticosteroids (ICS) on bone mineral density among COPD remains uncertain. There is the urgent need to examine whether the long-term ICS use may increase the risk of osteoporosis. In this nested case-control study retrieved from the Taiwan National Health Insurance Research Database from 2002 to 2017, the study aimed to investigate risk of osteoporosis associated with ICS, focusing on the dosage and duration of ICS therapy. Cases with osteoporosis or osteoporotic fractures claims were defined and matched to 3 randomly selected controls. Conditional logistic regressions were used to estimate odds ratios of osteoporosis from ICS treatment measured in 3 years before the index date. This population-based study included 891,395 patients with COPD, where after matching had 58,048 case groups and 174,144 matched control groups. After adjusting for potential confounders, ICS use in COPD was associated with a 1.053-fold (95% confidence interval 1.020-1.087) increased osteoporosis risk, where 7892 (13.59%) ICS use in case and 22,580 (12.97%) in control. New ICS use in COPD patients is associated with increased osteoporosis risk, regardless of exposure period.