Use of inhaled corticosteroids and the risk of fracture
Respiratory Medicine, Clinical Sciences Building, Nottingham City Hospital, NG5 1PB, Nottingham, UK. Chest
(Impact Factor: 7.48).
11/2006; 130(4):1082-8. DOI: 10.1378/chest.130.4.1082
Previous studies have found an association between the use of inhaled corticosteroids and fracture, but the extent to which this association is due to inhaled corticosteroids or to related factors, such as the severity of airflow obstruction, is disputed. We report a new approach in which we combine data on people with airflow obstruction from a large Medical Research Council study of the assessment and management of older people in the community with longitudinal data from their computerized general practice records.
Our cohort includes 1,671 study participants with a diagnosis of asthma or COPD (mean age, 80.6 years). We determined the dose-response relationship between inhaled corticosteroid exposure and time to first fracture using Cox regression, allowing for a wide range of potential confounding factors.
During a mean follow-up period of 9.4 years, 982 patients (59%) received a prescription for an inhaled corticosteroid and 187 patients had a fracture. After adjusting for the effects of age and gender, we found a dose-related increase in fracture risk with exposure to inhaled corticosteroids (rate ratio for mean daily dose > 601 mug, 2.53; 95% confidence interval [CI], 1.65 to 3.89; overall trend p < 0.0001). The results were similar after adjusting for oral corticosteroid exposure, airflow obstruction diagnosis, historical fracture, and bronchodilator use (rate ratio, 4.21; 95% CI, 2.19 to 8.13), and also in the subset of people with no exposure to oral corticosteroids (rate ratio, 4.54; 95% CI, 1.23 to 16.74).
Our findings provide further evidence that inhaled corticosteroid use is an independent risk factor for fracture.
Available from: PubMed Central
- "Vestegaard and colleagues found that chronic lung diseases like COPD and emphysema were associated with a 1.2- to 1.3-fold higher risk of fractures . Inhaled corticosteroids have also been associated with increased fracture risk [16, 17]. "
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ABSTRACT: In 5,541 community dwelling men, chronic obstructive pulmonary disease, or asthma was associated with lower bone mineral density (BMD) at the spine and total hip and an increased risk of vertebral and nonvertebral fractures independent of age, body mass index, and smoking. Men prescribed with corticosteroids had the lowest BMD.
It is unclear whether chronic obstructive pulmonary disease (COPD) is independently associated with BMD and fractures.
In 5,541 men from the Osteoporotic Fractures in Men Study, history of COPD or asthma, current treatment with corticosteroids, BMD, bone loss after 4.5 years and fractures were ascertained.
Seven hundred fourteen (13%) men reported COPD or asthma, of which 103 were prescribed an oral steroid and 177 an inhaled steroid. Independent of confounders, men prescribed corticosteroids for COPD or asthma had the lowest BMD and a 2-fold increased risk of vertebral osteoporosis compared to men with no history of COPD or asthma (OR 2.13, 95% CI (confidence interval) 1.15-3.93 oral steroids; OR 2.05, 95% CI 1.27-3.31 inhaled steroids). During follow-up, BMD increased at the spine, but there was no difference in bone loss at the hip. However, men with COPD or asthma had a 2.6- and 1.4-fold increased risk of vertebral and nonvertebral fractures, respectively.
Chronic obstructive pulmonary disease or asthma was associated with lower BMD at the spine and hip and increased risk of vertebral and nonvertebral fractures independent of age, clinic site, BMI, and smoking. A history of COPD or asthma may be a useful clinical risk factor to identify patients with osteoporosis.
Osteoporosis International 10/2009; 21(8):1341-9. DOI:10.1007/s00198-009-1076-x · 4.17 Impact Factor
Internal Medicine News 04/2010; 43(6). DOI:10.1016/S1541-9800(10)70213-1
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ABSTRACT: The optimization problems for the communication network have been
taken attentions by many related researchers, such as network designers,
network analysts, network administrators. And the use of computer
communication networks has been rapidly increasing in order to share
expensive hardware/software resources and provide access to main system
from distant locations. These network problems have many applications in
telecommunications, computer networking, and the related domains in
electric, gas, and sewer networks. Especially, in the computer
networking, LANs are commonly used as the communication infrastructure
that meets the demands of the users in local environment. These networks
typically consist of several LAN segments connected together via
bridges. The use of these transparent bridges requires loop-free paths
between LAN segments. Therefore, only spanning tree topologies can be
used as active LAN configurations. Recently, genetic algorithms have got
a great advancement in related research fields, such as network
optimization problem, combinatorial optimization, multiobjective
optimization, and so on. Also genetic algorithm have received a great
deal of attention about its ability as optimization techniques for many
real-world problem. In this paper, we attempt to the topology design
problem in LAN with bicriteria which is minimizing the cost and average
message delay using spanning tree-based genetic algorithm, because the
interconnection between the network service centers must yield spanning
tree configurations. Finally, we get some experiments in order to
certify the quality of the networks designs obtained by using spanning
tree-based genetic algorithm
Evolutionary Computation Proceedings, 1998. IEEE World Congress on Computational Intelligence., The 1998 IEEE International Conference on; 06/1998
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