Inhaled corticosteroids and hip fracture: disease or drugs?

Van Staa, Tjeerd P., Leufkens, Hubert G. M. and Cooper, Cyrus (2003) Inhaled corticosteroids and hip fracture: disease or drugs? American Journal of Respiratory and Critical Care Medicine, 168 (1), 128-129.

Abstract

Hubbard and colleagues report a study using the General Practice Research Database exploring the relationship between inhaled corticosteroids and the risk of hip fracture. In so doing, they replicate findings recently presented by our own group, but fail to interpret these with due care. Using the traditional epidemiological cohort study design, we identified all users of inhaled corticosteroids, and identified fracture incidence among them. We contrasted incidence rates with cohorts who used inhaled bronchodilator therapy, but did not use inhaled corticosteroids, and with a control cohort who were matched by age and sex to the inhaled corticosteroids users, but did not suffer from asthma. In contrast, Hubbard and colleagues commenced with the fractures and looked back at exposure history using a nested case–control design. The difference in methodology represents different types of sampling, and should give identical results if derived from the same population. The two studies did indeed produce almost identical results with respect to the relative rate of hip fracture in inhaled corticosteroid users, but varied in the evaluation of the role of the underlying disease.

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Contributors

Author: Cyrus Cooper

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