Table 3

Characteristics of observational studies of inhaled corticosteroids (ICS) and fractures

StudyDesignFracturesData sourceCOPD definition and patient characteristicsType of ICS
Gonnelli, 2010w27Cross-sectionalVertebral57 Italian outpatient pulmonary centres January–December 2005, 3030 eligible patientsAge >50 years, referred by family physicians for COPD, FEV1/FVC <70%, with recent lateral CXR. Mean age 70 years, 58% malesBDP, BUD, FP, TRIAM
Johannes, 2005w28Nested CCNon-vertebral mainly (64%) upper or lower limb fracturesUnited Healthcare database 1997–2001. 609 cases/6323 controlsAdults aged ≥40 years with ICD-9 codes for COPD and asthma (we used data on patients with COPD only). Mean age 52 years, 30% of cases were maleFP, BDP, BUD, FLUNIS, TRIAM
Lee, 2004w29Nested CCNon-vertebralVA patients; 1708 cases/6817 controlsNew patients with COPD identified by ICD-9 coding. Mean age 63 years, 95% male, with 1.8 years follow-upTRIAM, BDP, FLUNIS, FP
McEvoy, 1998w30Cross-sectionalVertebralMinneapolis VA 176 users/136 non-usersSelection criteria: (1) male >50 years old; (2) primary diagnosis COPD; (3) FEV1/FVC ratio 70%; (4) smoking history ≥20 pack-years; and (5) >5 refills of a β-agonist inhaler within past year. Mean age 69 yearsBDP, TRIAM
Pujades-Rodríguez, 2007w31Nested CCAnyUK Health Improvement Network database 1998–2005. 1235 cases/4598 controlsCOPD diagnosis based on general practice records. Mean age 69 years, 40% males. Mean predicted FEV1 of 58%. Controls matched by sex and general practiceBDP, FP, BUD
WEUSRTP1127 Miller, 2010w32 w34Nested CC Non-vertebral fractureNon-vertebralUK GPRD 2003–2006, 1523 cases/1876 controlsCOPD diagnosis on computerised records. Age ≥45 years, 37% male. Controls matched on age, sex, general practice and duration in cohort prior to index datePrimary analysis FP, incomplete reporting BDP and BUD data
WWE113669, 2008w33Nested CCNon-vertebralUK GPRD 1987–2000, 3105 cases/37 801 controls.COPD diagnosis on computerised records. Age 50–85 years, 66% male. Controls matched on age, sex and general practiceFP, BUD, BDP
  • BDP, beclomethasone; BUD, budesonide; CC, case–control; COPD, chronic obstructive pulmonary disease; CXR, chest x-ray; FEV1, forced expiratory volume in the first second of expiration; FLUNIS, flunisolide; FP, fluticasone, FVC, forced vital capacity; GPRD, General Practitioner Research Database; ICD, International Classification of Diseases; TRIAM, triamcinolone; VA, Veterans Affairs.