Archives of Osteoporosis

, 13:116 | Cite as

Long-term effects of inhaled corticosteroids on bone mineral density in older women with asthma or COPD: a registry-based cohort study

  • Wenjia Chen
  • Kate M. Johnson
  • J. Mark FitzGerald
  • Mohsen Sadatsafavi
  • William D. LeslieEmail author
Original Article



We assessed the association between long-term inhaled corticosteroid (ICS) use and bone mineral density (BMD) in older women with chronic respiratory disease. Women with > 50% adherence to ICS use had very slightly accelerated BMD loss at the total hip compared with those with lower or ICS use.


This study evaluated the impact of long-term ICS therapy on bone loss in older women with asthma or chronic obstructive pulmonary disease (COPD).


We used a population-based bone densitometry registry linked with administrative health data covering the province of Manitoba, Canada (1999–2013), to identify women aged > 40 years who had diagnosed asthma or COPD. ICS exposure was defined as cumulative dispensed days and medication possession ratio (MPR). Associations were examined both cross-sectionally and longitudinally, and results were covariate adjusted.


Among 6561 women with asthma and/or COPD (mean age 65 years [SD = 11]), compared to no ICS treatment, those in the highest tertile of prior ICS use (≥ 720 days) had lower BMD at the femoral neck (− 0.09 T-score, 95% CI − 0.16, − 0.02) and total hip (− 0.14 T-score, 95% CI − 0.22, − 0.05), but not at the lumbar spine. Over a mean of 5 years of follow-up, the highest tertile of ICS exposure (MPR > 0.5) was associated with a − 0.02 SD/year (95% CI − 0.04, − 0.01) greater decline in total hip BMD relative to non-users, with no significant effect at the femoral neck or lumbar spine. Middle and lower tertiles of ICS use were not associated with baseline or longitudinal change in BMD.


The highest tertile of ICS use was associated with a slightly lower hip BMD at baseline and slightly greater reduction in total hip BMD over time in older women with asthma or COPD. No adverse effects on BMD were seen from low to moderate ICS exposure.


Women Bone mineral density Inhaled corticosteroids Asthma Chronic obstructive pulmonary disease Osteoporosis 



The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Manitoba Population Research Data Repository under HIPC Project Number 2011/2012-31). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred. Data used in this study are from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba and were derived from data provided by Manitoba Health. This article has been reviewed and approved by the members of the Manitoba Bone Density Program.

Author contributions

WDL, MS, and JMF formulated the study idea. WDL designed the study and performed all data analyses. JMF and MS contributed to the study design and interpretation of findings. WC and KJ wrote the first draft of the manuscript (they are co-first authors). All authors critically commented on the manuscript and approved the final version. WDL is the guarantor of the manuscript.


No funding was received for this research project. MS receives salary support from the Canadian Institutes of Health Research and Michael Smith Foundation for Health Research.

Compliance with ethical standards

Conflict of interest

JMF has served on advisory boards for Novartis, Pfizer, AstraZeneca, Boehringer-Ingelheim, and Merck. He has also been a member of speakers’ bureaus for AstraZeneca, Boehringer-Ingelheim, Novartis, and Merck. He has received research funding paid directly to the University of British Columbia from AstraZeneca, Glaxo-SmithKline, Boehringer-Ingelheim, Merck, Sanofi, and Novartis. Dr. FitzGerald is a member of the Global Initiative for Asthma (GINA) Executive and Science Committees. Dr. Sadatsafavi receives salary support from the Canadian Institutes of Health Research and Michael Smith Foundation for Health Research. WDL, MS, KJ, and WC have no conflicts to declare.

Supplementary material

11657_2018_537_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Wenjia Chen
    • 1
    • 2
  • Kate M. Johnson
    • 1
  • J. Mark FitzGerald
    • 2
  • Mohsen Sadatsafavi
    • 1
    • 2
    • 3
  • William D. Leslie
    • 4
    Email author
  1. 1.Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
  2. 2.Institute for Heart and Lung Health, Department of MedicineThe University of British ColumbiaVancouverCanada
  3. 3.Centre for Clinical Epidemiology and EvaluationVancouver Coastal Health InstituteVancouverCanada
  4. 4.Department of Internal MedicineUniversity of ManitobaWinnipegCanada

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