Dose-response relationship for risk of non-vertebral fracture with inhaled corticosteroids

Clin Exp Allergy. 2008 Sep;38(9):1451-8. doi: 10.1111/j.1365-2222.2008.03029.x. Epub 2008 Jun 3.


Objective: To determine the strength of association between the dose of inhaled corticosteroids (ICS) and risk of non-vertebral fracture in adults.

Methods: A systematic review and meta-analysis of case-control studies of non-vertebral fractures in adults, in which at least two doses of ICS were reported as the dose of beclomethasone dipropionate (BDP) or equivalent.

Results: Five case-control studies were identified, with a total of 43 783 cases and 259 936 controls. There was an association between the risk of non-vertebral fracture and increasing dose of BDP. The random-effects odds ratio of relative risk for a non-vertebral fracture was 1.12 (95% confidence interval 1.00-1.26) per 1000 microg increase in the daily dose of BDP or equivalent.

Conclusion: In older adults, the relative risk of non-vertebral fractures increases by about 12% for each 1000 microg/day increase in the dose of BDP or equivalent. The magnitude of this risk was considerably less than other common risk factors for fracture in the older adult.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects*
  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Asthmatic Agents / administration & dosage
  • Anti-Asthmatic Agents / adverse effects*
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy*
  • Beclomethasone / administration & dosage
  • Beclomethasone / adverse effects*
  • Beclomethasone / therapeutic use
  • Case-Control Studies
  • Dose-Response Relationship, Drug
  • Fractures, Bone / chemically induced*
  • Humans
  • Risk


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Beclomethasone