Abstract
In an ageing population the prevalence of osteoporosis and chronic respiratory diseases is expected to increase in the near future. Interestingly, several forms of corticosteroids, drugs implicated in osteoporosis pathogenesis, are prescribed to respiratory patients without taking into consideration their age and risk for osteoporotic fractures. The aim of this study was to investigate the risk for hip fracture of the elder individuals who are taking corticosteroids for respiratory disease, including inhalers. Data on incident hip fractures were collected through the active follow-up for all individuals participating in the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC-Greece) study who were 60 years or older at recruitment and reported "a doctor's diagnosis" of respiratory disease. Socio-demographic, life-style, health status data and use of corticosteroids were recorded from the baseline and follow-up questionnaires. Cox regression models were applied to estimate hazard ratios (HRs) adjusting for relevant confounders. We observed an increase in hip fracture risk with corticosteroid intake overall (HR: 1.68, 95% CI: 0.85-3.34). Increased risk persisted when we restricted our analysis to participants taking any form of corticosteroids for obstructive lung disease (HR: 1.40, 95% CI: 0.64-3.06) and to those using only inhalers (HR: 1.58, 95% CI: 0.71-3.50). However, these positive associations did not reach the nominal level of significance probably due to the small number of participants with hip fractures during follow-up. Hip fracture risk should be taken into consideration when recommending corticosteroids to the elder respiratory patients, including inhalers.
Highlights
In an ageing population the prevalence of osteoporosis and chronic respiratory diseases is expected to increase in the near future
In the present study, conducted in the context of the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC-Greece) study, we investigate the risk for hip fracture of elder individuals who are taking corticosteroids for a respiratory disease
Corticosteroid intake increased hip fracture risk in all elderly participants reporting respiratory disease (HR: 1.68, 95% CI: 0.85–3.34) as well as to those with obstructive lung disease (HR: 1.40, 95% CI: 0.64–3.06)
Summary
In an ageing population the prevalence of osteoporosis and chronic respiratory diseases is expected to increase in the near future. Several forms of corticosteroids, drugs implicated in osteoporosis pathogenesis, are prescribed to respiratory patients without taking into consideration their age and risk for osteoporotic fractures. Increased risk persisted when we restricted our analysis to participants taking any form of corticosteroids for obstructive lung disease (HR: 1.40, 95% CI: 0.64–3.06) and to those using only inhalers (HR: 1.58, 95% CI: 0.71–3.50). These positive associations did not reach the nominal level of significance probably due to the small number of participants with hip fractures during follow-up.
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