Inhaled corticosteroids and hip fracture - A population-based case-control study
Inhaled corticosteroids and hip fracture - A population-based case-control study
复制标题
DOI：
10.1164/rccm.200206-606oc
复制
发表时间：
2002-12-15
影响因子：
24.7
通讯作者：
Tattersfield, AE
中科院分区：
文献类型：
--
作者：
Hubbard, RB;Smith, CJP;Tattersfield, AE
越来越多的证据表明，使用吸入性皮质类固醇与剂量相关的骨密度降低有关。这是否意味着骨折的增加尚不清楚。我们使用全科医学研究数据库进行病例对照分析，包括16，341例髋部骨折病例（平均年龄79岁，79%为女性，中位处方时间2.7年）和29，889例对照受试者，按年龄、性别和全科医学进行个体匹配。提取所有皮质类固醇处方和潜在混杂因素（包括其他药物使用和合并症）的数据，并使用条件logistic回归分析吸入性皮质类固醇暴露的影响。髋部骨折的风险与吸入性皮质类固醇暴露相关，比值比为1.26（95%置信区间，1.17至1.36）。在调整了口服皮质类固醇的年度疗程模型后，该比值比降低，这是唯一值得注意的混杂因素（OR 1.19; 95%CI，1.10至1.28）。即使调整了口服皮质类固醇的年度疗程数后，吸入性皮质类固醇的使用与髋部骨折之间也存在剂量-反应关系（p趋势= 0.007）。在老年受试者中，近期使用吸入性皮质类固醇与剂量相关的髋部骨折增加有关。
There is accumulating evidence that the use of inhaled corticosteroids is associated with a dose-related reduction in bone mineral density. Whether this translates to an increase in fracture is unclear. We have used the General Practice Research Database to perform a case-control analysis, including 16,341 cases of hip fracture (mean age of 79 years, 79% female, median period prescribing data 2.7 years) and 29,889 control subjects, individually matched by age, sex, and general practice. Data for all prescriptions for corticosteroids and for potential confounders, including other drug use and comorbid illnesses, were extracted, and the impact of inhaled corticosteroid exposure was analyzed using conditional logistic regression. The risk of hip fracture was associated with exposure to inhaled corticosteroids with an odds ratio of 1.26 (95% confidence interval, 1.17 to 1.36). This odds ratio was reduced after adjusting the model for annual courses of oral corticosteroids, the only confounder of note (OR 1.19; 95% CI, 1.10 to 1.28). There was a dose-response relationship between inhaled corticosteroid use and hip fracture even after adjusting for the annual number of courses of oral corticosteroids (p trend = 0.007). In older subjects, the recent use of inhaled corticosteroids is associated with a dose-related increase in hip fracture.