Use of steroid in COPD patients and the risk of femur neck fracture; nested case control study

초록

Background and Aims: Acute exacerbation of COPD is a sudden worsening of COPD symptoms that typically lasts for several days, in which case a systemic steroid is used. The use of steroids is a risk factor for fracture, which is judged to increase the risk of fracture in COPD patients. This study analyzed the factors that could increase the risk of femur neck fracture in COPD patient cohort.Methods: We analyzed a cohort of 587,534 COPD patients with over 40 years old from Korean National Health Insurance Service-National Sample Cohort between 2002 and 2015, comparing 267 out of 1497 patients with femur neck fractures by matching them 1:8.Results: The risk of femur neck fracture increased when cumulative steroid use exceeds 90 days in COPD cohort patients (hazard ratio [HR] 3.30; 95% confidence interval [CI] 1.87-5.81), otherwise, patients using less than 90 days of steroids did not increase (HR 1.09; 95% CI 0.82-1.44). The hazard ratio was increased in both men and women (HR 3.05; 95% CI 1.48-6.27 vs. HR 3.89; 95% CI 1.49-10.14, respectively), and both under 65 and over 65 years old (HR 7.36; 95% CI 2.20-24.59 vs. HR 2.66; 95% CI 1.38-5.15, respectively), and both osteoporosis and osteoporosis-free patients. (HR 3.16; 95% CI 1.02-9.79 vs. HR 3.26; CI 1.54-6.89).