None to be declared.
Use of beta-2 agonists and risk of hip/femur fracture: a population-based case-control study†
Version of Record online: 25 SEP 2006
Copyright © 2006 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 16, Issue 6, pages 612–619, June 2007
How to Cite
de Vries, F., Pouwels, S., Bracke, M., Leufkens, H. G.M., Cooper, C., Lammers, J.-W. J. and van Staa, T.-P. (2007), Use of beta-2 agonists and risk of hip/femur fracture: a population-based case-control study. Pharmacoepidem. Drug Safe., 16: 612–619. doi: 10.1002/pds.1318
- Issue online: 4 JUN 2007
- Version of Record online: 25 SEP 2006
- Manuscript Accepted: 26 JUL 2006
- Manuscript Revised: 25 JUL 2006
- Manuscript Received: 26 JUN 2006
- adrenergic beta-agonists;
- femoral fractures;
- anti-inflammatory agents;
- lung diseases obstructive;
- epidemiologic factors
Administration of beta-2 agonists decreased bone mineral density in rats. But the association between bronchodilators and fracture risk has not been studied in humans.
To examine the association between use of beta-2 agonists and risk of hip/femur fracture.
We conducted a population-based case-control study (6763 cases) in the Dutch PHARMO database. Current beta-2 agonist use was compared to never use. We adjusted for severity of the underlying respiratory disease and disease and drug history.
A hospitalisation for asthma/COPD in the year before index date increased risk of hip/femur fracture: crude OR 2.17 (95% CI, 1.41–3.34). Patients using higher doses of beta-2 agonists had increased risk of hip/femur fracture: crude OR 1.94 (95% CI, 1.41–2.66) for daily dosages of ≥1600 µg albuterol equivalent. The excess fracture risk reduced after adjustment for disease severity (1.46; 95% CI, 1.02–2.08) and after exclusion of oral glucocorticoid users (1.31; 95% CI, 0.80–2.15). Risk of hip/femur fracture was similar between users of beta-2 agonists, inhaled glucocorticoids and anticholinergics.
We found increases in the risk of hip/femur fracture in patients using higher doses of beta-2 agonists. However, the excess risk of hip/femur fracture substantially reduced after exclusion of oral glucocorticoid users and after adjustment for the underlying disease. Risk of hip/femur fracture was similar between users of beta-2 agonists, inhaled glucocorticoids and anticholinergics. The severity of the underlying disease, rather than the use of beta-2 agonists, may play an important role in the aetiology of hip/femur fractures in patients using beta-2 agonists. Copyright © 2006 John Wiley & Sons, Ltd.