Inhaled corticosteroids can reduce osteoporosis in female patients with COPD

Figures & data

Figure 1 Flow chart of patient selection.

Notes: This is a retrospective cohort and population-based study in which we extracted newly diagnosed female patients with COPD between 1997 and 2009 from Taiwan’s National Health Insurance (TNHI) database between 1996 and 2011 (ICD-9-CM 491, 492, 496). The patients with COPD were defined by the presence of two or more diagnostic codes for COPD within 12 months on either inpatient or outpatient service. Patients were excluded if they were younger than 40 years or if osteoporosis had been diagnosed prior to the diagnosis of COPD and cases of asthma (ICD-9 CM code 493.X) before the index date. These enrolled patients (n=10,723) were followed up till 2011 and the incidence of osteoporosis was determined.
Abbreviation: ICD-9-CM, International Classification of Diseases, Ninth Revision – Clinical Modification.

Table 1 Demographic characteristics of patients in the cohort

Variables	ICS use				Total
	Yes		No
	n	%	n	%	n	%
Age (years)
≥40 to <50	161	19.83	1,988	20.06	2,149	20.04
≥50 to <60	191	23.52	2,018	20.36	2,209	20.60
≥60	460	56.65	5,905	59.58	6,365	59.36
Income (NTD)
<15,840	476	58.62	5,521	55.71	5,997	55.93
≥15,840 to <21,900	80	9.85	1,203	12.14	1,283	11.96
≥21,900 to <34,800	183	22.54	2,337	23.58	2,520	23.50
≥34,800	73	8.99	850	8.58	923	8.61
Baseline comorbidities
Tuberculosis	94	11.58	566	5.71	660	6.15
Bacterial pneumonia	104	12.81	560	5.65	664	6.19
Bronchiectasis	152	18.72	730	7.37	882	8.23
Pulmonary fibrosis	24	2.96	65	0.66	89	0.83
Hypertension	612	75.37	6,432	64.90	7,044	65.69
Diabetes mellitus	350	43.23	3,600	36.32	3,951	36.85

Abbreviations: ICS, inhaled corticosteroids; NTD, New Taiwan Dollars.

Table 2 Numbers of patients with osteoporosis and the incident rate per 100,000 person-years

Variables	No of patients	No of person-years	No of patients with osteoporosis	Incident rate (per 100,000 person-years)
Age (years)
≥40 to <50	2,149	17,276.56	389	2,251.61
≥50 to <60	2,209	15,719.91	668	4,249.39
≥60	6,365	46,833.45	2,329	4,972.94
Income (NTD)
<15,840	5,997	4,4751.27	1,973	4,408.81
≥15,840 to <21,900	1,283	1,0757.61	361	3,355.76
≥21,900 to <34,800	2,520	1,7577.67	863	4,909.64
≥34,800	923	6,743.36	189	2,802.76
Medication
Estrogen
No	9,407	70,133.46	2,784	3,969.57
Yes	1,316	9,696.46	602	6,208.45
LABA
No	10,360	76,744.50	3,328	4,336.47
Yes	363	3,085.42	58	1,879.81
LAMA
No	10,659	79,289.20	3,381	4,264.14
Yes	64	540.72	5	924.69
Oral steroid
Yes	65,23	45,110.75	2,217	4,914.57
No	42,00	34,719.17	1,169	3,367.02
SABA
No	9,637	70,356.94	3,089	4,390.47
Yes	1,086	9,472.98	297	3,135.23
ICS use
No ICS use	9,911	72,559.76	3,189	4,395.00
Any ICS use	812	7,270.16	197	2,709.71
>0 mg to ≤20 mg	358	3,016.27	93	3,083.28
>20 mg to ≤60 mg	208	1,900.12	49	2,578.79
>60 mg	246	2,353.77	55	2,336.68

Abbreviations: ICS, inhaled corticosteroids; NTD, New Taiwan Dollars; SABA, short-acting beta-agonist; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist.

Table 3 The crude HR of osteoporosis incident rate per 100,000 person-years in variable categories

Variables	Crude HR (95% CI)
Age (years)
≥40 to <50	1.00
≥50 to <60	1.85 (1.63–2.10)
≥60	2.22 (1.99–2.47)
Income (NTD)
<15,840	1.00
≥15,840 to <21,900	0.80 (0.71–0.89)
≥21,900 to <34,800	1.08 (0.99–1.17)
≥34,800	0.62 (0.53–0.72)
Medication
Estrogen
No	1.00
Yes	1.59 (1.46–1.74)
LABA
No	1.00
Yes	0.44 (0.34–0.57)
LAMA
No	1.00
Yes	0.22 (0.09–0.53)
Oral steroid
Yes	1.00
No	0.70 (0.65–0.75)
SABA
No	1.00
Yes	0.74 (0.66–0.84)
ICS use
No ICS use	1.00
Any ICS use	0.64 (0.56–0.74)
>0 mg to ≤20 mg	0.72 (0.58–0.88)
>20 mg to ≤60 mg	0.61 (0.46–0.81)
>60 mg	0.56 (0.43–0.74)
	P for trend <0.0001

Abbreviations: CI, confidence interval; HR, hazard ratio; ICS, inhaled corticosteroids; NTD, New Taiwan Dollars; SABA, short-acting beta-agonist; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist.

Table 4 The HR of osteoporosis incident rate per 100,000 person-years in variable ICS dose

ICS dose	Adjusted HRa (95% CI)
No ICS use	1.00
Any ICS use	0.80 (0.68–0.92)
>0 mg to ≤20 mg	0.84 (0.69–1.04)
>20 mg to ≤60 mg	0.78 (0.59–1.04)
>60 mg	0.72 (0.55–0.96)
	P for trend =0.0023

Note:

a Adjusted for age, income, and use of medications (estrogen, oral steroid, LABA, LAMA, and SABA).

Abbreviations: CI, confidence interval; HR, hazard ratio; ICS, inhaled corticosteroid; SABA, short-acting beta-agonist; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist.

Figure 2 The cumulative osteoporosis probability among the ICS users compared with nonusers.

Note: The cumulative osteoporosis probability significantly decreased among the ICS users compared with nonusers (P<0.001).
Abbreviation: ICS, inhaled corticosteroid.