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Published ahead of print on October 9, 2003, doi:10.1164/rccm.200305-640OC
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American Journal of Respiratory and Critical Care Medicine Vol 169. pp. 83-88, (2004)
© 2004 American Thoracic Society

Inhaled and Nasal Corticosteroid Use and the Risk of Fracture

Samy Suissa, Marc Baltzan, Richard Kremer and Pierre Ernst

Divisions of Clinical Epidemiology and Endocrinology, Royal Victoria Hospital, McGill University Health Centre; Department of Epidemiology and Biostatistics and of Medicine, McGill University; Department of Respiratory Medicine, Mount Sinai Hospital; and Division of Respiratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada

Correspondence and requests for reprints should be addressed to Samy Suissa, Ph.D., Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.29, Montreal, PQ, H3A 1A1 Canada. E-mail: samy.suissa{at}clinepi.mcgill.ca

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-µg 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 µg 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.

Key Words: asthma • cohort studies • chronic obstructive pulmonary disease • glucocorticoids • osteoporosis




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