Inhaled and nasal corticosteroid use and the risk of fracture

Am J Respir Crit Care Med. 2004 Jan 1;169(1):83-8. doi: 10.1164/rccm.200305-640OC. Epub 2003 Oct 9.


Studies of the risk of fracture associated with inhaled corticosteroids are inconclusive and are limited to short-term effects. We assessed whether long-term use increases this risk. We conducted a case control study nested within a population-based cohort of all Quebec elderly dispensed respiratory medications and followed for at least 4 years during 1988-2001. There were 9,624 new cases of fracture of the hip or upper extremities and 191,622 age-matched control subjects (mean age of 81 years). The rate of any such fracture for current inhaled corticosteroid use was not elevated (rate ratio [RR], 0.97; 95% confidence interval [CI], 0.92-1.03). For upper-extremity fracture, the rate increased by 12% (RR, 1.12; 95% CI, 1.04-1.19) with every 1,000-microg increase in the daily dose of inhaled corticosteroids, but not for hip fracture (RR, 0.97; 95% CI, 0.88-1.07). Among subjects followed for over 8 years, the rate of hip fracture was only elevated with daily doses of more than 2,000 microg of inhaled corticosteroids (RR, 1.61; 95% CI, 1.04-2.50). The rate was not elevated at any dose of nasal corticosteroids. In conclusion, the long-term use of inhaled and nasal corticosteroids at the usual recommended doses is not associated with a risk of fracture in older patients with respiratory disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Administration, Intranasal
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects*
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Asthma / drug therapy
  • Canada / epidemiology
  • Case-Control Studies
  • Cohort Studies
  • Confidence Intervals
  • Dose-Response Relationship, Drug
  • Female
  • Hip Fractures / chemically induced*
  • Hip Fractures / epidemiology
  • Humans
  • Humeral Fractures / chemically induced*
  • Humeral Fractures / epidemiology
  • Incidence
  • Long-Term Care
  • Male
  • Middle Aged
  • Probability
  • Reference Values
  • Risk Assessment


  • Adrenal Cortex Hormones