Inhaled or systematic corticosteroids and the risk of hospitalizations for hip fracture among elderly women

Systemic corticosteroid therapy leads to bone lossand increases fracture risk, especially with highdoses and prolonged use. Detrimental effects on bone metabolism are assumed to be lower with inhaled corticosteroids, given their limited systemic absorption (1% to 10%). However, it is unclear to what extent inhaled corticosteroids cause clinical fractures. Studies in patients with asthma have not consistently found an association between inhaled corticosteroid use and bone mineral density, perhaps because of small samples, short follow-ups, or confounding by previous systemic corticosteroid use.

Postmenopausal women are at high risk of hip fractures from systemic corticosteroid use, but the risks of inhaled corticosteroid use are largely unknown in these patients. We therefore aimed to determine the relation between inhaled corticosteroid use and hip fractures in elderly women, and to compare the rates of hip fracture in women who used inhaled or systemic corticosteroids.