Evaluating inhaled corticosteroids' impact on osteoporosis and fracture risk in COPD patients: a real-world evidence-based systematic review and meta-analysis
BackgroundThe impact of current inhaled corticosteroid (ICS) therapies on fracture risk in patients with chronic obstructive pulmonary disease (COPD) remains uncertain.ObjectiveThis study conducts a systematic review and meta-analysis to assess the risk of fractures associated with ICS use over at l...
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Frontiers Media S.A.
2025-06-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1503475/full |
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| author | Hsiao-Feng Huang Chin-Wei Hsu Chin-Wei Hsu Chin-Wei Hsu Fei-Ting Hsieh Kuang-Ming Liao Kuang-Ming Liao |
| author_facet | Hsiao-Feng Huang Chin-Wei Hsu Chin-Wei Hsu Chin-Wei Hsu Fei-Ting Hsieh Kuang-Ming Liao Kuang-Ming Liao |
| author_sort | Hsiao-Feng Huang |
| collection | DOAJ |
| description | BackgroundThe impact of current inhaled corticosteroid (ICS) therapies on fracture risk in patients with chronic obstructive pulmonary disease (COPD) remains uncertain.ObjectiveThis study conducts a systematic review and meta-analysis to assess the risk of fractures associated with ICS use over at least 4 years, synthesizing evidence from observational studies conducted in real-world settings among individuals with COPD.MethodsWe systematically searched PubMed, EMBASE, Scopus, and Web of Science from inception to April 21, 2025. Inclusion criteria encompassed studies conducted in COPD patients, evaluating interventions involving ICS-containing treatments compared to alternatives or no ICS use, using cohort or case-control designs, and reporting outcomes related to osteoporosis or fractures. Pooled odds ratios (OR) and hazard ratios (HR) were calculated using random-effects models. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity.ResultsNine studies (six case-control, three cohort) were included. The pooled OR from case-control studies was 1.03 (95% CI: 0.99–1.08; I2 = 50%), and the pooled HR from cohort studies was 0.95 (95% CI: 0.67–1.33; I2 = 86%). Subgroup analyses indicated a potential increased risk in Asian and European populations but not in North America. Meta-regression revealed that higher oral corticosteroids exposure was significantly associated with increased risk (p = 0.005, R2 = 100%).ConclusionsAlthough ICS did not significantly impact osteoporosis or fracture risk, these are common comorbidities in COPD patients. Methodological differences, such as study design, outcome definitions, and oral corticosteroids use, may influence result interpretation and contribute to heterogeneity, limiting study comparability. |
| format | Article |
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| institution | Kabale University |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj-art-7102cbfb7db8463a8c6f285e10188c6e2025-08-20T03:26:15ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-06-011210.3389/fmed.2025.15034751503475Evaluating inhaled corticosteroids' impact on osteoporosis and fracture risk in COPD patients: a real-world evidence-based systematic review and meta-analysisHsiao-Feng Huang0Chin-Wei Hsu1Chin-Wei Hsu2Chin-Wei Hsu3Fei-Ting Hsieh4Kuang-Ming Liao5Kuang-Ming Liao6Department of Pharmacy, Chi Mei Medical Center, Chiali, TaiwanDepartment of Pharmacy, Chi Mei Medical Center, Tainan, TaiwanSchool of Pharmacy, Kaohsiung Medical University, Kaohsiung, TaiwanInstitute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Pharmacy, Chi Mei Medical Center, Chiali, TaiwanDepartment of Internal Medicine, Chi Mei Medical Center, Chiali, TaiwanDepartment of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, TaiwanBackgroundThe impact of current inhaled corticosteroid (ICS) therapies on fracture risk in patients with chronic obstructive pulmonary disease (COPD) remains uncertain.ObjectiveThis study conducts a systematic review and meta-analysis to assess the risk of fractures associated with ICS use over at least 4 years, synthesizing evidence from observational studies conducted in real-world settings among individuals with COPD.MethodsWe systematically searched PubMed, EMBASE, Scopus, and Web of Science from inception to April 21, 2025. Inclusion criteria encompassed studies conducted in COPD patients, evaluating interventions involving ICS-containing treatments compared to alternatives or no ICS use, using cohort or case-control designs, and reporting outcomes related to osteoporosis or fractures. Pooled odds ratios (OR) and hazard ratios (HR) were calculated using random-effects models. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity.ResultsNine studies (six case-control, three cohort) were included. The pooled OR from case-control studies was 1.03 (95% CI: 0.99–1.08; I2 = 50%), and the pooled HR from cohort studies was 0.95 (95% CI: 0.67–1.33; I2 = 86%). Subgroup analyses indicated a potential increased risk in Asian and European populations but not in North America. Meta-regression revealed that higher oral corticosteroids exposure was significantly associated with increased risk (p = 0.005, R2 = 100%).ConclusionsAlthough ICS did not significantly impact osteoporosis or fracture risk, these are common comorbidities in COPD patients. Methodological differences, such as study design, outcome definitions, and oral corticosteroids use, may influence result interpretation and contribute to heterogeneity, limiting study comparability.https://www.frontiersin.org/articles/10.3389/fmed.2025.1503475/fullchronic obstructive pulmonary diseaseinhaled corticosteroidsmeta-analysissystematic reviewosteoporosisfracture |
| spellingShingle | Hsiao-Feng Huang Chin-Wei Hsu Chin-Wei Hsu Chin-Wei Hsu Fei-Ting Hsieh Kuang-Ming Liao Kuang-Ming Liao Evaluating inhaled corticosteroids' impact on osteoporosis and fracture risk in COPD patients: a real-world evidence-based systematic review and meta-analysis Frontiers in Medicine chronic obstructive pulmonary disease inhaled corticosteroids meta-analysis systematic review osteoporosis fracture |
| title | Evaluating inhaled corticosteroids' impact on osteoporosis and fracture risk in COPD patients: a real-world evidence-based systematic review and meta-analysis |
| title_full | Evaluating inhaled corticosteroids' impact on osteoporosis and fracture risk in COPD patients: a real-world evidence-based systematic review and meta-analysis |
| title_fullStr | Evaluating inhaled corticosteroids' impact on osteoporosis and fracture risk in COPD patients: a real-world evidence-based systematic review and meta-analysis |
| title_full_unstemmed | Evaluating inhaled corticosteroids' impact on osteoporosis and fracture risk in COPD patients: a real-world evidence-based systematic review and meta-analysis |
| title_short | Evaluating inhaled corticosteroids' impact on osteoporosis and fracture risk in COPD patients: a real-world evidence-based systematic review and meta-analysis |
| title_sort | evaluating inhaled corticosteroids impact on osteoporosis and fracture risk in copd patients a real world evidence based systematic review and meta analysis |
| topic | chronic obstructive pulmonary disease inhaled corticosteroids meta-analysis systematic review osteoporosis fracture |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1503475/full |
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