Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd., Sanmin District, Kaohsiung, 80708, Taiwan, ROC.
Department of Pharmacy, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin District, Kaohsiung, 80708, Taiwan, ROC.
Sci Rep. 2021 Jan 12;11(1):724. doi: 10.1038/s41598-020-80815-y.
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.
慢性阻塞性肺疾病（COPD）的特征是气流受限，骨质疏松症是与 COPD 预后不良相关的主要合并症。然而，吸入皮质类固醇（ICS）对 COPD 患者骨密度的影响仍不确定。迫切需要检查长期使用 ICS 是否会增加骨质疏松症的风险。在这项 2002 年至 2017 年从台湾全民健康保险研究数据库中提取的嵌套病例对照研究中，研究旨在调查与 ICS 相关的骨质疏松症风险，重点关注 ICS 治疗的剂量和持续时间。骨质疏松症或骨质疏松性骨折的病例定义为骨质疏松症或骨质疏松性骨折的病例，并与 3 名随机选择的对照者相匹配。使用条件逻辑回归估计从索引日期前 3 年 ICS 治疗的骨质疏松症的比值比。这项基于人群的研究包括 891395 例 COPD 患者，匹配后有 58048 例病例组和 174144 例匹配对照组。在调整了潜在混杂因素后，COPD 患者使用 ICS 与骨质疏松症风险增加 1.053 倍（95%置信区间 1.020-1.087）有关，其中病例组中有 7892 名（13.59%）和对照组中有 22580 名（12.97%）患者使用 ICS。新的 ICS 在 COPD 患者中的使用与骨质疏松症风险增加有关，而与暴露期无关。
