Tsai Chun-Hao, Liao Lin-Yu, Lin Cheng-Li, Chung Wei-Sheng
Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.
Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.
Clin Respir J. 2018 May;12(5):1830-1837. doi: 10.1111/crj.12744. Epub 2017 Dec 7.
Inhaled corticosteroids (ICSs) are crucial anti-inflammatory medications for chronic airway diseases. Studies investigating the relationship between ICSs and fractures in Asian populations are scant. We investigated whether ICSs increased the risk of low-energy fractures in patients with chronic airway diseases.
We used the Longitudinal Health Insurance Database to select patients aged 20 years and older with chronic airway diseases (asthma and COPD) between 2000 and 2011 as the base cohort. We identified ICS users and ICS non-users matched by propensity score method at 1:1 ratio. Cox proportional hazard regression models were used to calculate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for factors associated with the risk of fracture.
A total of 1,182 ICS users and 1,182 controls were enrolled. After adjustment for age, gender, annual exacerbation number of acute respiratory events, comorbidity and medications, the risk of fracture was 1.10 for ICS users (aHR = 1.20; 95% CI = 1.10-1.31) compared with ICS non-users. The ICS users exhibited significantly 1.63-fold risk of hip fracture and 1.24-fold risk of ulna and radius fracture than did the ICS non-users. Patients with medium and high doses of ICS use were associated with significantly increased risks of fracture (aHR = 1.48, 95% CI = 1.25-1.76 for medium dose and aHR = 1.55, 95% CI = 1.39-1.72 for high dose) compared with those in ICS non-users.
Patients with medium and high doses of ICS use are associated with an increased risk of fracture.
吸入性糖皮质激素（ICSs）是治疗慢性气道疾病的关键抗炎药物。关于ICSs与亚洲人群骨折之间关系的研究较少。我们调查了ICSs是否会增加慢性气道疾病患者发生低能量骨折的风险。
我们使用纵向健康保险数据库，选取2000年至2011年间年龄在20岁及以上的慢性气道疾病（哮喘和慢性阻塞性肺疾病）患者作为基础队列。我们采用倾向评分法以1:1的比例确定ICS使用者和非使用者。使用Cox比例风险回归模型计算与骨折风险相关因素的调整后风险比（aHR）和95%置信区间（CI）。
共纳入1182名ICS使用者和1182名对照者。在调整年龄、性别、急性呼吸事件的年度加重次数、合并症和药物治疗后，与非ICS使用者相比，ICS使用者的骨折风险为1.10（aHR = 1.20；95%CI = 1.10 - 1.31）。ICS使用者发生髋部骨折的风险比非使用者显著高1.63倍，尺桡骨骨折风险高1.24倍。与非ICS使用者相比，中高剂量使用ICS的患者骨折风险显著增加（中剂量aHR = 1.48，95%CI = 1.25 - 1.76；高剂量aHR = 1.55，95%CI = 1.39 - 1.72）。
中高剂量使用ICS的患者骨折风险增加。
