Risk of osteoporotic fractures in elderly asthmatic patients according to prescription patterns of systemic corticosteroid: a retrospective cohort study

Background The use of systemic corticosteroids in older adult patients with asthma raises concerns regarding the increased osteoporotic fracture risk. This study aimed to evaluate the risk of osteoporotic fractures among older adult patients with asthma according to the intensity of dose accumulation of systemic corticosteroids (rapid versus gradual attainment of the same cumulative dose). Methods This retrospective cohort study used data from the Health Insurance Review and Assessment Service Database in Korea. Patients aged ≥ 65 years who were diagnosed with asthma in 2016 and treated with systemic corticosteroids within 6 months were included. Patients were categorized into high- and low-intensity groups (both cumulative dose ≥ 450 mg, prednisolone equivalent within ≤ 90 vs. >90 days). Propensity score matching was used to balance the confounding variables. Cox proportional hazards model was used to assess the risk of osteoporotic fractures. Results Of the 6,342 older adult patients with asthma, the high- and low-intensity groups included 4,391 and 1,951 patients, respectively. After matching, each group included 1,783 patients. The osteoporotic fracture incidence rates were 50.18/1,000 person-years and 52.58/1,000 person-years in the high- and low-intensity groups, respectively. No significant difference was observed in the fracture risk between the two groups (hazard ratio, 0.95; 95% confidence interval, 0.78–1.15). Sensitivity analyses using multivariate adjustments and competing risk approaches confirmed the robustness of these findings. Conclusions Osteoporotic fracture risk did not significantly differ between the high- and low-intensity corticosteroid prescription groups among older adult patients with asthma, suggesting that rapid accumulation of a high cumulative corticosteroid dose warrants careful fracture risk monitoring. This study provides exploratory real-world evidence to inform future evaluation of the reimbursement criteria for osteoporosis medications in short-term corticosteroid users.