Lee Todd A, Weiss Kevin B
Midwest Center for Health Services and Policy Reseach, Hines VA Hospital, Hines, IL 60141, USA.
Am J Respir Crit Care Med. 2004 Apr 1;169(7):855-9. doi: 10.1164/rccm.200307-926OC. Epub 2004 Jan 7.
Patients with chronic obstructive pulmonary disease (COPD) are frequently treated with inhaled corticosteroids (ICS). However, the impact of ICS use on fracture risk remains unclear in these patients. This nested case-control study examines the association between ICS use and nonvertebral fractures in Veterans Affairs patients with COPD. From a cohort of 40,157 patients with a COPD diagnosis between October 1, 1998 and September 30, 1999, and that used services in the preceding 12-month period but did not have a COPD diagnosis, 1,708 cases with nonvertebral fractures were identified and matched to 6,817 control patients. Patients were 94% male, and average age was 62.7 years. ICS exposure was identified through prescription records and converted to beclamethasone equivalents. In conditional logistic regression models, exposure to ICS at any time during follow-up was not associated with an increased fracture risk (adjusted odds ratio = 0.97; 95% confidence interval, 0.84-1.11). However, current high-dose ICS users (> or = 700 microg per day) had an increased risk of fractures compared with patients with no exposure (adjusted odds ratio = 1.68; 95% confidence interval, 1.10-2.57). In patients with COPD, current use of high-dose ICS was associated with an increased risk of nonvertebral fractures.
慢性阻塞性肺疾病（COPD）患者经常接受吸入性糖皮质激素（ICS）治疗。然而，在这些患者中，使用ICS对骨折风险的影响仍不明确。这项巢式病例对照研究探讨了美国退伍军人事务部COPD患者使用ICS与非椎骨骨折之间的关联。在1998年10月1日至1999年9月30日期间被诊断为COPD且在之前12个月内使用过医疗服务但未被诊断为COPD的40157名患者队列中，识别出1708例非椎骨骨折病例，并与6817名对照患者进行匹配。患者中94%为男性，平均年龄为62.7岁。通过处方记录确定ICS暴露情况，并将其转换为倍氯米松等效剂量。在条件逻辑回归模型中，随访期间任何时间的ICS暴露与骨折风险增加无关（调整后的优势比=0.97；95%置信区间，0.84-1.11）。然而，与未暴露的患者相比，当前高剂量ICS使用者（≥700微克/天）骨折风险增加（调整后的优势比=1.68；95%置信区间，1.10-2.57）。在COPD患者中，当前使用高剂量ICS与非椎骨骨折风险增加相关。
