title: Association between corticosteroid use and vertebral fractures in older men with chronic obstructive pulmonary disease.
abstract: Osteoporosis is a major complication of long-term corticosteroid administration, but the magnitude of the effect in patients with chronic obstructive pulmonary disease (COPD) is not well defined. In a cross-sectional study, we evaluated the association between steroid use and vertebral fractures in 312 men, 50 yr of age or older, with COPD. Subjects were evaluated according to their corticosteroid use: Never Steroid Users (NSU) (n = 117), Inhaled Steroid Users (ISU) (n = 70), and Systemic Steroid Users (SSU) (n = 125). The prevalence of one or more vertebral fractures was 48.7% in the NSU group, 57.1% in the ISU group, and 63.3% in the SSU group. Compared with NSU, SSU were two times as likely to have one or more vertebral fractures: age-adjusted odds ratio (OR) = 1.80; 95% CI, 1.08 to 3.07. This relationship was primarily due to a strong association between continuous systemic steroid use and vertebral fractures: age-adjusted OR = 2.36; 95% CI, 1.26 to 4.38. In addition, fractures in SSU were more likely to be multiple and more severe. A weaker relationship existed between inhaled steroid use and vertebral fractures: age-adjusted OR = 1.35; 95% CI, 0.77 to 2.56 compared with NSU. These data indicate that vertebral fractures are common in older men with COPD; the likelihood of these fractures is greatest in those men using continuous systemic steroids.
authors.affiliation: Department of Medicine, University of Minnesota Medical School, and VA Medical Center, Minneapolis 55417, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: McEvoy
authors.forename: K E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: E
authors.initials: E
authors.lastname: Bender
authors.forename: H K
authors.initials: HK
authors.lastname: Genant
authors.forename: W
authors.initials: W
authors.lastname: Yu
authors.forename: J M
authors.initials: JM
authors.lastname: Griffith
authors.forename: D E
authors.initials: DE
authors.lastname: Niewoehner
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001507:Beclomethasone / Q000008:administration & dosage / Q000627:therapeutic use; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005069:Evaluation Studies as Topic; D005541:Forced Expiratory Volume; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008173:Lung Diseases, Obstructive / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000139:chemically induced; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D015995:Prevalence; D012907:Smoking / Q000503:physiopathology; D016103:Spinal Fractures / Q000139:chemically induced*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use; D014797:Vital Capacity
chemical_list: D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D001507:Beclomethasone; D011241:Prednisone