Inhaled and nasal corticosteroid use and the risk of fracture.
Studies of the risk of fracture associated with inhaled corticosteroids are inconclusive and are limited to short-term effects. We assessed whether long-term use increases this risk. We conducted a case control study nested within a population-based cohort of all Quebec elderly dispensed respiratory medications and followed for at least 4 years during 1988-2001. There were 9,624 new cases of fracture of the hip or upper extremities and 191,622 age-matched control subjects (mean age of 81 years). The rate of any such fracture for current inhaled corticosteroid use was not elevated (rate ratio [RR], 0.97; 95% confidence interval [CI], 0.92-1.03). For upper-extremity fracture, the rate increased by 12% (RR, 1.12; 95% CI, 1.04-1.19) with every 1,000-microg increase in the daily dose of inhaled corticosteroids, but not for hip fracture (RR, 0.97; 95% CI, 0.88-1.07). Among subjects followed for over 8 years, the rate of hip fracture was only elevated with daily doses of more than 2,000 microg of inhaled corticosteroids (RR, 1.61; 95% CI, 1.04-2.50). The rate was not elevated at any dose of nasal corticosteroids. In conclusion, the long-term use of inhaled and nasal corticosteroids at the usual recommended doses is not associated with a risk of fracture in older patients with respiratory disease.
Suissa
Samy
S
Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada. samy.suissa@clinepi.mcgill.ca
Baltzan
Marc
M
Kremer
Richard
R
Ernst
Pierre
P
D000280:Administration, Inhalation; D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy; D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D005260:Female; D006620:Hip Fractures / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D006810:Humeral Fractures / Q000139:chemically induced* / Q000453:epidemiology; D015994:Incidence; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment
D000305:Adrenal Cortex Hormones