Because the research subjects were mostly men age 60 and older, the findings raise perhaps more troubling questions about the medication's effects on women with COPD, a group already at a significantly higher risk than men for fractures.
"There are millions of COPD patients who use long-term inhaled corticosteroids in the United States and millions more across the world," says Sonal Singh, M.D., M.P.H., an assistant professor of general internal medicine at the Johns Hopkins University School of Medicine and the senior author of the study published online in the journal Thorax. "The number of people who are getting fractures because of these medications is quite large."
The inhaled corticosteroids evaluated were fluticasone, sold in combination with salmeterol as Advair, and budesonide, sold in combination with formoterol as Symbicort. Although applied through the mouth, the body absorbs corticosteroids, which have long been linked to a decline in bone density. Until now, no reliable association had been found to fractures in patients with COPD, Singh says.
Singh and his colleagues reviewed and analyzed two different sets of research studies comparing inhaled corticosteroids to a placebo in COPD patients. One study looked at 16 long-term double-blind randomized controlled trials with more than 17,500 participants; the other examined seven observational studies with 69,000 participants. In both, the researchers found a significantly increased risk of fractures for those using inhaled corticosteroids. The observational studies also found evidence of dose-response that fracture risk increased as steroid dosage increased.
Recent research has linked other popular medications to increased fracture risk, notably proton-pump inhibitors given for heartburn and some diabetes drugs, such as rosiglitazone (Avandia) and pioglitazone (Actos).
Inhaled corticosteroids are used to reduce the frequency of hospitalizations in patients with moderate to severe COPD. "Patients need to know about this risk along with the benefits of these inhaled medications," Singh says. "People who continue to use inhaled corticosteroids should pay attention to bone health and consider the lowest possible dose for the shortest possible time. The risks may be somewhat mitigated with bone-building drugs."
Patients with COPD, the researchers note, are already at a high risk of osteoporosis and fractures, which may stem from nutritional deficiencies or previous corticosteroid use. At larger doses, adverse effects of inhaled corticosteroids may come close to that of oral steroids, which are well known to increase bone loss and decrease bone formation.
Singh says he would like the U.S. Food and Drug Administration to look into the issues discovered in this research by his team and his colleagues from the University of East Anglia in the United Kingdom and the University of Louisville in the United States.
Although many asthma patients also take inhaled corticosteroids, Singh says his research does not apply to that mostly younger cohort since they were not included in the study.
Singh says he is most concerned about those who were not the focus of this study: women.
"It was surprising to find an increased risk of fractures in this study where two-thirds of the participants were men over the age of 60," Singh says. "It really makes us wonder what is happening to women with COPD who use inhalers, because older women are already at a much higher fracture risk than men."
This study was supported by the National Institutes of Health's National Center for Research Resources and the NIH's Roadmap for Medical Research.
For more information: http://www.hopkinsmedicine.org/gim/faculty/Singh.html
Stephanie Desmon | EurekAlert!
Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT
Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.
Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
02.12.2016 | Medical Engineering
02.12.2016 | Agricultural and Forestry Science
02.12.2016 | Physics and Astronomy