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Published ahead of print on October 9, 2003, doi:10.1164/rccm.200305-640OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 1, January 2004, 83-88

A more recent version of this article appeared on January 1, 2004
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Submitted on May 12, 2003
Accepted on October 8, 2003

Inhaled Corticosteroid Use and the Risk of Fracture

Samy Suissa1*, Marc Baltzan2, Richard Kremer3, and Pierre Ernst4

1 Division of Clinical Epidemiology, McGill University Health Centre - Royal Victoria Hospital, Montreal, Quebec, Canada; Epidemiology, Biostatistics and Medicine, McGill University, Montreal, Quebec, Canada, 2 Division of Clinical Epidemiology, McGill University Health Centre - Royal Victoria Hospital, Montreal, Quebec, Canada; Respiratory Medicine, Mount Sinai Hospital, Montreal, Quebec, Canada, 3 Division of Endocrinology, McGill University Health Centre - Royal Victoria Hospital, Montreal, Quebec, Canada, 4 Division of Clinical Epidemiology, McGill University Health Centre - Royal Victoria Hospital, Montreal, Quebec, Canada; Epidemiology, Biostatistics and Medicine, McGill University, Montreal, Quebec, Canada; Division of Respiratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada

* To whom correspondence should be addressed. E-mail: SAMY.SUISSA{at}clinepi.mcgill.ca.

We conducted a population-based case-control study nested within a cohort of elderly patients dispensed respiratory medications in order to assess whether long-term use of inhaled and nasal corticosteroids increases the risk of fracture. There were 8,044 new cases of fracture of the hip or upper extremities and 138,102 age-matched controls with a mean age of 81 years. The rate of any such fracture for current use of inhaled corticosteroids was not elevated (rate ratio 0.96; 95% CI: 0.91-1.01). After adjustment, the rate of fracture increased by 6% (rate ratio 1.06; 95% CI: 1.00-1.12) for every 1000 µg increase in the daily dose of inhaled corticosteroids. The risk was not elevated for hip fracture considered separately, but for fractures of the upper extremities, their was a small increase of 12% (rate ratio 1.12; 95% CI: 1.04-1.19) per 1000 µg increase in the daily dose of inhaled corticosteroids. The rate was not elevated at any dose of nasal corticosteroids. In conclusion, the use of inhaled and nasal corticosteroids is not associated with a significantly increased risk of fracture of the hip or upper extremities in elderly patients with respiratory disease when used at the usual recommended doses over a 4 year period.
Key words: COPD, Cohort studies, Osteoporosis, glucocorticoids, Fracture




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