van Staa T P, Leufkens H G, Cooper C
Department of Pharmacoepidemiology and Pharmacotherapy, University of Utrecht, The Netherlands.
J Bone Miner Res. 2001 Mar;16(3):581-8. doi: 10.1359/jbmr.2001.16.3.581.
Treatment with systemic corticosteroids is known to increase the risk of fractures but little is known of the fracture risks associated with inhaled corticosteroids. A retrospective cohort study was conducted using a large UK primary care database (the General Practice Research Database [GPRD]). Inhaled corticosteroid users aged 18 years or older were compared with matched control patients and to a group of noncorticosteroid bronchodilator users. Patients with concomitant use of systemic corticosteroids were excluded. The study comprised 170,818 inhaled corticosteroid users, 108,786 bronchodilator users, and 170,818 control patients. The average age was 45.1 years in the inhaled corticosteroid, 49.3 years in the bronchodilator, and 45.2 years in the control groups. In the inhaled corticosteroid cohort, 54.5% were female. The relative rates (RRs) of nonvertebral, hip, and vertebral fractures during inhaled corticosteroid treatment compared with control were 1.15 (95% CI, 1.10-1.20), 1.22 (95% CI, 1.04-1.43), and 1.51 (95% CI, 1.22-1.85), respectively. No differences were found between the inhaled corticosteroid and bronchodilator groups (nonvertebral fracture RR = 1.00; 95% CI, 0.94-1.06). The rates of nonvertebral fractures among users of budesonide (RR = 0.95; 95% CI, 0.85-1.07) and fluticasone propionate (RR = 1.03; 95% CI, 0.71-1.49) were similar to the rate determined for users of beclomethasone dipropionate. We conclude that users of inhaled corticosteroids have an increased risk of fracture, particularly at the hip and spine. However, this excess risk may be related more to the underlying respiratory disease than to inhaled corticosteroid.
已知全身使用皮质类固醇会增加骨折风险，但对于吸入性皮质类固醇相关的骨折风险却知之甚少。我们利用英国一个大型初级医疗数据库（全科医疗研究数据库[GPRD]）进行了一项回顾性队列研究。将18岁及以上的吸入性皮质类固醇使用者与匹配的对照患者以及一组非皮质类固醇支气管扩张剂使用者进行比较。排除同时使用全身皮质类固醇的患者。该研究包括170,818名吸入性皮质类固醇使用者、108,786名支气管扩张剂使用者和170,818名对照患者。吸入性皮质类固醇组的平均年龄为45.1岁，支气管扩张剂组为49.3岁，对照组为45.2岁。在吸入性皮质类固醇队列中，54.5%为女性。与对照组相比，吸入性皮质类固醇治疗期间非椎骨、髋部和椎骨骨折的相对发生率（RRs）分别为1.15（95%CI，1.10 - 1.20）、1.22（95%CI，1.04 - 1.43）和1.51（95%CI，1.22 - 1.85）。吸入性皮质类固醇组和支气管扩张剂组之间未发现差异（非椎骨骨折RR = 1.00；95%CI，0.94 - 1.06）。布地奈德使用者（RR = 0.95；95%CI，0.85 - 1.07）和丙酸氟替卡松使用者（RR = 1.03；95%CI，0.71 - 1.49）的非椎骨骨折发生率与二丙酸倍氯米松使用者的发生率相似。我们得出结论，吸入性皮质类固醇使用者骨折风险增加，尤其是髋部和脊柱。然而，这种额外风险可能更多地与潜在的呼吸系统疾病有关，而非与吸入性皮质类固醇有关。
