Dose-response relationship for risk of non-vertebral fracture with inhaled corticosteroids.
OBJECTIVE
To determine the strength of association between the dose of inhaled corticosteroids (ICS) and risk of non-vertebral fracture in adults.


METHODS
A systematic review and meta-analysis of case-control studies of non-vertebral fractures in adults, in which at least two doses of ICS were reported as the dose of beclomethasone dipropionate (BDP) or equivalent.


RESULTS
Five case-control studies were identified, with a total of 43 783 cases and 259 936 controls. There was an association between the risk of non-vertebral fracture and increasing dose of BDP. The random-effects odds ratio of relative risk for a non-vertebral fracture was 1.12 (95% confidence interval 1.00-1.26) per 1000 microg increase in the daily dose of BDP or equivalent.


CONCLUSIONS
In older adults, the relative risk of non-vertebral fractures increases by about 12% for each 1000 microg/day increase in the dose of BDP or equivalent. The magnitude of this risk was considerably less than other common risk factors for fracture in the older adult.
Weatherall
M
M
University of Otago Wellington, Wellington, New Zealand.
James
K
K
Clay
J
J
Perrin
K
K
Masoli
M
M
Wijesinghe
M
M
Beasley
R
R
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D050723:Fractures, Bone / Q000139:chemically induced*; D006801:Humans; D012306:Risk
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D001507:Beclomethasone