Use of inhaled corticosteroids and the risk of fracture
Use of inhaled corticosteroids and the risk of fracture
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DOI：
10.1378/chest.130.4.1082
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发表时间：
2006-10-01
期刊：
影响因子：
9.6
通讯作者：
Fletcher, Astrid
中科院分区：
文献类型：
--
作者：
Hubbard, Richard;Tattersfield, Anne;Fletcher, Astrid
背景资料：以前的研究已经发现使用吸入性皮质类固醇和骨折之间的关联，但这种关联在多大程度上是由于吸入性皮质类固醇或相关因素，如气流阻塞的严重程度，是有争议的。我们报告了一种新的方法，我们结合联合收割机数据的人与气流阻塞的大型医学研究理事会研究的评估和管理的老年人在社区与纵向数据从他们的计算机化的一般practice records.Methods：我们的队列包括1,671名研究参与者诊断为哮喘或慢性阻塞性肺病（平均年龄，80.6岁）。我们确定了吸入性皮质类固醇暴露和首次骨折的时间之间的剂量反应关系，使用考克斯回归，允许广泛的潜在的混杂factors.Results：在平均随访期为9.4年，982例（59%）接受了吸入性皮质类固醇的处方和187例患者骨折。在调整年龄和性别的影响后，我们发现吸入性皮质类固醇暴露与骨折风险呈剂量相关性增加（平均日剂量> 601 μ g的率比为2.53; 95%置信区间[CI]为1.65 - 3.89;总体趋势p < 0.0001）。在调整口服皮质类固醇暴露、气流后，结果相似。梗阻诊断、骨折史和支气管扩张剂使用（率比4.21; 95%CI 2.19 - 8.13），以及未接触口服皮质类固醇的人群（率比4.54; 95%CI 1.23 - 16.74）。结论：我们的研究结果进一步证明吸入性皮质类固醇使用是骨折的独立危险因素。
Background: 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. We report a new approach in which we combine data on people with airflow obstruction from a large Medical Research Council study of the assessment and management of older people in the community with longitudinal data from their computerized general practice records.Methods: Our cohort includes 1,671 study participants with a diagnosis of asthma or COPD (mean age, 80.6 years). We determined the dose-response relationship between inhaled corticosteroid exposure and time to first fracture using Cox regression, allowing for a wide range of potential confounding factors.Results: During a mean follow-up period of 9.4 years, 982 patients (59%) received a prescription for an inhaled corticosteroid and 187 patients had a fracture. After adjusting for the effects of age and gender, we found a dose-related increase in fracture risk with exposure to inhaled corticosteroids (rate ratio for mean daily dose > 601 mu g, 2.53; 95% confidence interval [CI], 1.65 to 3.89; overall trend p < 0.0001). The results were similar after adjusting for oral corticosteroid exposure, airflow. obstruction diagnosis, historical fracture, and bronchodilator use (rate ratio, 4.21; 95% CI, 2.19 to 8.13), and also in the subset of people with no exposure to oral corticosteroids (rate ratio, 4.54; 95% CI, 1.23 to 16.74).Conclusions: Our findings provide further evidence that inhaled corticosteroid use is an independent risk factor for fracture.