Table 4.

Conflicting evidence for increased risk of bone mineral density loss with inhaled corticosteroids

Study description	Outcome	Reference
Lung Health Study: randomized, placebo-controlled study of triamcinolone in patients with COPD (n = 1116)	Significantly lower bone density of the femur and lumbar spine versus placebo, but no increased risk of bone fracture	Lung Health Study Research Group72
Case–control analysis of patients with hip fracture in general practice (n = 16,341 cases and 29,899 controls)	Higher risk of hip fracture with inhaled corticosteroids	Hubbard et al73
Case–control study in COPD patients of the association between inhaled corticosteroid use and vertebral fractures (n = 1708 cases and 6817 controls)	High doses of inhaled corticosteroid were associated with an increased risk of vertebral fracture	Lee and Weiss74
Randomized, placebo-controlled trial of budesonide in patients with COPD (n = 912)	No change in bone mineral density or fracture rates versus placebo	Johnell et al75
TORCH: randomized, double-blind, placebo- and active-controlled trial of salmeterol and fluticasone in patients with COPD (n = 658)	No increased risk of bone mineral density loss or fractures with fluticasone or salmeterol-fluticasone combination versus placebo	Ferguson et al76

Notes: Shaded areas indicate studies showing increased risk; unshaded areas indicate studies showing no increased risk.

Abbreviations: COPD, chronic obstructive pulmonary disease; TORCH, TOwards a Revolution in COPD Health.