Inhaled corticosteroids associated with increased fracture risk

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NEW YORK (Reuters Health), Oct 31 - Use of inhaled corticosteroids is an independent risk factor for fracture, according to findings published in the October issue of Chest.

"Previous studies have found an association between the use of inhaled corticosteroids and fracture, but the extent to which this association is due to inhaled corticosteroids or to related factors, such as the severity of airflow obstruction, is disputed," Dr. Richard Hubbard, of the University of Nottingham, U.K., and colleagues write.

To quantify the dose-response relationship between the use of inhaled corticosteroids and fracture, the researchers combined data from a study of older people in the community with airflow obstruction and longitudinal data from their computerized general practice records.

Included in the analysis were 1671 subjects (mean age 80.6 years) with a diagnosis of asthma or COPD. Cox regression analysis was used to assess the dose-response relationship between inhaled corticosteroid exposure and time to first fracture.

Over a nine-year period, 982 patients (59%) received at least one prescription for an inhaled corticosteroid during follow-up. The median daily dose prescribed was 219 µg.

A total of 187 subjects had an incident fracture. There were 69 fractures among 689 nonusers of inhaled corticosteroids, and 118 among the 982 subjects who were exposed to inhaled steroids.

For people with a mean daily dose of greater than 600 mcg versus no use of inhaled steroids, the rate ratio for fracture was 2.53 after adjusting for age and gender (overall trend p < 0.0001), the team calculates. After adjusting for oral corticosteroid exposure, airflow obstruction diagnosis, historical fracture, and bronchodilator use, the rate ratio was 4.21.

The researchers say their results demonstrate that the risk of fracture is increased in users of inhaled corticosteroids, and this increase is not explained by exposure to oral corticosteroids or level of physical activity.

"This conclusion is consistent with the evidence from clinical trials and observational studies that suggest that inhaled corticosteroids have systemic adverse effects on bone," Dr. Hubbard's team writes. "Given the frequent use of these drugs in the general population, this has important public health implications."

Last Updated: 2006-10-31 10:27:12 -0400 (Reuters Health)

Chest 2006;130:1082-1088.

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