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Inhaled corticosteroids (ICS) are recommended for the management of moderate to severe chronic obstructive pulmonary disease (COPD).1 2 Previous investigations on the adverse effects of ICS on bone health in individuals with COPD have yielded conflicting results. Some trials3 have found that ICS can worsen bone mineral density (BMD) but not fracture risk, whereas other studies4 5 have found no such effect. Meta-analyses have also yielded contradictory findings.6 7 Understanding the strength and characteristics of this association is important as fractures can have serious …
Competing interests None.