title: Corticosteroids and hip fracture risk in elderly respiratory patients: EPIC-Greece cohort.
abstract: In an ageing population the prevalence of osteoporosis and chronic respiratory diseases is expected to increase in the near future. Interestingly, several forms of corticosteroids, drugs implicated in osteoporosis pathogenesis, are prescribed to respiratory patients without taking into consideration their age and risk for osteoporotic fractures. The aim of this study was to investigate the risk for hip fracture of the elder individuals who are taking corticosteroids for respiratory disease, including inhalers.
  
  
  
  Data on incident hip fractures were collected through the active follow-up for all individuals participating in the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC-Greece) study who were 60 years or older at recruitment and reported "a doctor's diagnosis" of respiratory disease. Socio-demographic, life-style, health status data and use of corticosteroids were recorded from the baseline and follow-up questionnaires. Cox regression models were applied to estimate hazard ratios (HRs) adjusting for relevant confounders.
  
  
  
  We observed an increase in hip fracture risk with corticosteroid intake overall (HR: 1.68, 95% CI: 0.85-3.34). Increased risk persisted when we restricted our analysis to participants taking any form of corticosteroids for obstructive lung disease (HR: 1.40, 95% CI: 0.64-3.06) and to those using only inhalers (HR: 1.58, 95% CI: 0.71-3.50). However, these positive associations did not reach the nominal level of significance probably due to the small number of participants with hip fractures during follow-up.
  
  
  
  Hip fracture risk should be taken into consideration when recommending corticosteroids to the elder respiratory patients, including inhalers.
authors.affiliation: akarakats@med.uoa.gr.
authors.forename: Anna
authors.initials: A
authors.lastname: Karakatsani
authors.forename: Michail
authors.initials: M
authors.lastname: Katsoulis
authors.forename: Eleni
authors.initials: E
authors.lastname: Klinaki
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D015519:Bone Density / Q000187:drug effects*; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006115:Greece; D006620:Hip Fractures / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D012044:Regression Analysis
chemical_list: D000305:Adrenal Cortex Hormones
keywords: EPIC-Greece; corticosteroids; elderly; hip fracture; respiratory disease