ASSOCIATION BETWEEN CORTICOSTEROID USE AND VERTEBRAL FRACTURES IN OLDER MEN WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Osteoporosis is a major complication of long-term corticosteroid admin istration, but the magnitude of the effect in patients with chronic ob structive pulmonary disease (CORD) is not well defined. In a cross-sec tional study, we evaluated the association between steroid use and ver tebral fractures in 312 men, 50 yr of age or older, with CORD. Subject s were evaluated according to their corticosteroid use: Never Steroid Users (NSU) (n = 117), Inhaled Steroid Users (ISU) (n = 70), and Syste mic Steroid Users (SSU) (n = 125). The prevalence of one or more verte bral fractures was 48.7% in the NSU group, 57.1% in the ISU group, and 63.3% in the SSU group. Compared with NSU, SSU were two times as like ly to have one or more vertebral fractures: age-adjusted odds ratio (O R) = 1.80; 95% CI, 1.08 to 3.07. This relationship was primarily due t o a strong association between continuous systemic steroid use and ver tebral fractures: age-adjusted OR = 2.36; 95% CI, 1.26 to 4.38. In add ition, fractures in SSU were more likely to be multiple and more sever e. A weaker relationship existed between inhaled steroid use and verte bral fractures: age-adjusted OR = 1.35; 95% CI, 0.77 to 2.56 compared with NSU. These data indicate that vertebral fractures are common in o lder men with CORD; the likelihood of these fractures is greatest in t hose men using continuous systemic steroids.