COPD Inhalers May Increase Risk of Bone Fractures, Researchers Warn

Side effects of Advair, Pulmicort and other similar COPD inhalers appear to increase the risk of bone fractures, but researchers have not been able to determine the mechanism of action.

Individuals who use some of the most popular inhalers to combat the symptoms of chronic obstructive pulmonary disease (COPD) may face an increased risk of bone fractures, according to the findings of a new study.

Chinese researchers say inhalers like Pulmicort and Advair, which contain corticosteroids, could increase a person’s risk of bone fractures by 19%. That risk could increase to nearly 50% if they are using double or triple-strength inhalers, the researchers warn in findings published this month in the journal BMC Pulmonary Medicine.

COPD is a group of lung diseases that include emphysema and chronic bronchitis. The conditions stem from inflammatory lung symptoms like blocked lung airflow and difficulty breathing. Damage to the lungs is permanent and cannot be reversed, and regular symptoms include shortness of breath, wheezing, or chronic cough.

Roughly 16 million Americans currently live with COPD. There is no cure for the disease, but it can be treated to reduce symptoms and discomfort. Corticosteroid inhalers are often used to prevent the symptoms of asthma and COPD and help to reduce inflammation in the lungs.

COPD Inhaler Bone Fracture Risks

In this new study, researchers from China conducted a systematic review and meta-analysis of 44 randomized control trials involving nearly 88,000 patients, looking for fracture risks for COPD patients treated with inhaled corticosteroids.

According to their findings, using corticosteroid inhalers increased a person’s risk of suffering a bone fracture by 19%. The risk was greater if the patient was using combination therapy or triple therapy. Combination therapy, the use of inhaled corticosteroids and long-acting beta-agonists (LABA), increased the risk by 30%.

The highest risk was seen among those using triple therapy or inhaled corticosteroids, combined with two LABA medications plus a long-acting muscarinic antagonist, who faced a 49% increased risk of bone fractures.

Patients who were treated with inhaled corticosteroids for longer than 12 months, who were older, and who had Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II disease also faced a significantly increased risk of bone fractures.

Using budesonide, the active ingredient in Pulmicort, and fluticasone therapy, sold under the brand name Advair, were also linked with an increased fracture risk. Previous studies have also warned that Pulmicort may increase the risk of death among infants.

The findings are similar to previous research published in 2021, which also found that the use of topical corticosteroids may also increase the risk of bone fractures and osteoporosis, especially at higher doses.

Researchers noted that COPD patients tend to be elderly and have various complications, which may also increase their risk of fracture. The exact reason inhaled corticosteroids increase bone fracture risks is unknown, but it may be linked to patient malnutrition, inflammatory response in the body, and previous use of corticosteroids.

Many therapies, including double and triple therapies, can improve the quality of life in a patient who has COPD, however it is important for patients to discuss both the long-term risks and benefits with their doctor before beginning treatment with inhalant corticosteroids, the researchers advised.