Endocrinol Metab.  2025 Feb;40(1):82-92. 10.3803/EnM.2024.1990.

Elevated Fracture Risks in Patients Using Inhaled Corticosteroids: A Korean Nationwide Study

• Kong SH
• Jo AJ
• Park CM
• Park KI
• Yun JE
• Kim JH

• KMID: 2565256
• DOI: http://doi.org/10.3803/EnM.2024.1990

Abstract

Background
In this comprehensive retrospective nationwide cohort study, we examined the relationships between various asthma medications and bone health, utilizing data from the National Health Insurance Service database of South Korea.
Methods
From 2015 to 2019, the relevant dataset included 168,611 individuals aged 66 years, among whom 8,747 were diagnosed with asthma. We focused on a subset of 6,173 patients, all 66-year-old women. Participants were categorized into four groups: nonusers of asthma medication (n=2,868), leukotriene antagonist users (n=2,281), inhaled corticosteroid (ICS) users (n=517), and those using a combination of ICS and long-acting beta-agonist (ICS+LABA) medication (n=507). The primary outcomes measured were the incidences of major osteoporotic fractures and hip fractures during the follow-up period.
Results
Over 2.7 years of follow-up, 615 cases of major osteoporotic fractures and 96 cases of hip fractures were recorded. ICS users exhibited a heightened risk of both injuries, with hazard ratios of 1.38 (95% confidence interval [CI], 1.18 to 1.63; P<0.001) for major osteoporotic fractures and 1.56 (95% CI, 1.33 to 1.83; P<0.001) for hip fractures. Similarly elevated risks were observed in the ICS+LABA group. Notably, the risk associated with ICS was particularly pronounced among patients with osteopenia for both fracture types. Overall, the use of ICS, alone or in combination with LABA, in patients with asthma is associated with significantly increased risks of osteoporotic fractures, especially among those with osteopenia.
Conclusion
These findings underscore the importance of considering bone health when managing asthma, especially in older patients and those with existing bone density issues.

Keyword

Asthma; Fracture; Osteoporosis; Inhaled corticosteroids

Figure

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  Fig. 1. Selection of study participants. LTA, leukotriene antagonist; ICS, inhaled corticosteroid; LABA, long-acting beta-agonist.

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  Fig. 2. Risk of major (A) osteoporotic fracture and (B) hip fracture in patients with asthma by medication(s) used. LTA, leukotriene antagonist; HR, hazard ratio; CI, confidence interval; ICS, inhaled corticosteroid; LABA, long-acting beta-agonist.

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