Widely Used COPD Meds Tied to Increased Fracture Risk

Widely Used COPD Meds Tied to Increased Fracture Risk

TUESDAY, Feb. 13, 2018 (HealthDay News) — Many patients with chronic obstructive pulmonary disease (COPD) are placed on powerful inhaled corticosteroid therapy to ease symptoms.

But new research suggests the treatment might raise their odds for bone fractures.

Still, the Canadian study wasn’t able to prove cause-and-effect, and the overall risk remained small, said one expert not connected to the study.

“Looking at their data, there would be an estimated 1 [extra] fracture for every 241 patients using high-dose inhaled corticosteroids for over four years,” said Dr. Walter Chua. He’s the senior attending physician for pulmonary care at Northwell Health’s Long Island Jewish Forest Hills hospital in Forest Hills, N.Y.

Chua believes that although steroids may raise bone fracture risk, “patients should not panic as the risk of fracture is small and we have ways of monitoring that risk.”

COPD — often linked to smoking — is a combination of emphysema and chronic bronchitis. It is a progressive, debilitating illness that currently has no cure. COPD remains the number three killer of Americans.

Many COPD patients are given inhaled corticosteroid medications to help alleviate symptoms. But, according to the study team, prior research has suggested that the drugs may reduce bone mineral density, particularly in postmenopausal women.

The new study was led by Dr. Samy Suissa of McGill University in Montreal. His team tracked outcomes for more than 240,000 COPD patients, aged 55 and older, in the Canadian province of Quebec.

During an average follow-up of just over five years, the overall fracture rate was just over 15 people per 1,000 patients per year.

However, the rate was higher among patients who had used inhaled corticosteroids for longer than four years, at daily doses of 1,000 micrograms or more.

Gender didn’t seem to play a role, since the risk rose equally for men and women, Suissa’s team said.

The study appears in the February issue of the journal Chest.

“Since fractures are more frequent in women than men, our study suggests that the excess number of fractures associated with [inhaled corticosteroids] will be greater in women — even though we did not find that the risk increase was particularly higher in women than in men,” Suissa said in a journal news release.

So what does this mean for the many COPD patients who are using corticosteroids?

Dr. Ann Tilley is a pulmonologist at Lenox Hill Hospital, in New York City. She wasn’t involved in the new research, but read over the findings and stressed that it couldn’t prove cause-and-effect.

Information on other patient factors that might raise bone fracture — things like smoking status, obesity and exercise levels — weren’t accounted for, Tilley noted.

Still, “the most important take-home message here is that long-term use of high-dose inhaled steroids may not be without risk,” Tilley said, “and we should try to minimize their use when possible.”

“I would encourage patients to talk to their doctors about their inhalers and ask specifically if they need to be using an inhaled corticosteroid, and if so, could a lower dose be tried,” she said.

Chua agreed, noting that other research has also shown “a slight uptick in the rates of pneumonia [for COPD patients] while on inhaled corticosteroids.”

He believes that for patients with confirmed COPD, “inhalers containing corticosteroids should generally be reserved as a last line of treatment after optimization of other inhaler alternatives.”

And if patients must use steroids, they “should be monitored for bone mineral density and fracture risk, for which we have medications/therapies to help reduce that risk,” Chua said.

More information

The U.S. National Heart, Lung, and Blood Institute has more on COPD.

SOURCES: Walter Chua, MD , senior pulmonary attending physician, Northwell Health’s Long Island Jewish Forest Hills, Forest Hills, NY; Ann Tilley, MD, pulmonologist, Lenox Hill Hospital, New York City; Chest, news release, Feb. 5, 2018

Tips for preventing ski injuries

Tips for preventing ski injuries

Ski season is in full swing — but an injury can put you out of commission until next year’s first snowfall. Here’s how to stay safe on the slopes all winter long.

While many people huddle inside during the winter months, away from “bomb cyclones” and blizzards, a select few know that the best way to beat wintry weather is to embrace it — on the ski slopes, that is!

As any seasoned skier will tell you, however, their beloved sport does come with the risk of injury. Fortunately, taking some simple precautions before you hit the slopes can help you stay in peak condition regardless of how many tumbles you take.

We’ve outlined some of the most common injuries that afflict skiers, and what you can do to prevent them.

MCL Injuries

A number of injuries can affect the medial collateral ligament (MCL), but the most common by far is an MCL tears. In skiing, MCL tears most often occur when the skier falls while attempting to slow or stop in a snowplow position, in which the tips of the skis are pointed toward each other. To avoid injury in this position, make sure to always keep your weight balanced. In addition, sticking to runs with which you’re comfortable can reduce the need to enter the snowplow position at all.

ACL Injuries

A variety of falls on the slopes can result in a tear of the anterior cruciante ligament (ACL). It most commonly happens after a forward fall, during which the inner edge of the front of the ski becomes embedded in the snow, trapping the leg in the process. It can also occur when the top of the back of the boot pushes the tibia (the weight-bearing bone in the leg) forward, away from the femur. On other occasions, it arises when the skier leans back on the skis, loses balance, and falls backward. Strengthening the hamstrings, wearing proper bindings, and using shorter skis can all reduce the risk of sustaining an ACL tear.

Fractures

Like torn ligaments, fractures are most commonly caused by falls while skiing. The wrist and ankles are particularly susceptible to breaks. To help avoid broken bones, always wear adequate protective gear and practice proper techniques for falling. Increasing cardiovascular endurance and developing the surrounding muscles can also be beneficial.

Shoulder Dislocations

Most shoulder dislocations happen when skiers fall, either directly onto the shoulder or onto an outstretched hand or arm. This injury results in heavy, immediate pain, significantly restricts the shoulder’s range of motion, and can leave it misshapen. Since dislocations are caused by sudden trauma, they can be difficult to anticipate, but strengthening the rotator cuff muscles, especially if you have previously dislocated your shoulder, can lower the risk of a dislocation. As with other common skiing injuries, employing proper form will also minimize the possibility of a dislocation.

Spinal Injuries

Aside from protecting the spinal cord, the spine ensures the strength and stability of the back. It is made up of various bony segments called vertebrae separated by pieces of fibrocartilaginous tissue called intervertebral discs, any of which can be injured while skiing. Some ways to avoid spinal injuries include using spine protectors, sticking to trails on which you are comfortable, using proper equipment, and learning the technique for “safe” falls.

While some ski injuries are immediately apparent, others can be more subtle, slowly progressing with time. Fortunately, the talented team of specialists at New York Bone and Joint has extensive experience working in sports medicine and can quickly diagnose and treat any of these common problems. If you think you may have suffered an injury during your latest trip to the mountain, call us today to schedule a consultation, or if the injury has been recent, stop in to our Orthopedic Urgent Care!