Thirteen studies were included in the review (number of participants not reported): four randomised controlled trials (RCTs), three cohort studies and six case-control studies.
There was no evidence of an increased risk of any fracture for patients treated with inhaled corticosteroids (RR 1.02, 95% CI 0.96 to 1.08; 13 studies). Subgroup analyses reported an increased risk of any fractures among high-dose inhaled corticosteroid participants compared to control (RR 1.30, 95% CI 1.07 to 1.58); there was no increased risk related to subgroup analyses of setting or study. There was evidence of statistical heterogeneity for some analyses, but there were no significant changes to the results when studies responsible for heterogeneity were removed from these analyses.
There was evidence of a reduced risk of hip fractures for patients treated with inhaled corticosteroids (RR 0.91, 95% CI 0.87 to 0.96; six studies), but no evidence of increased risk for hip fractures in community settings, COPD patients or high-dose inhaled corticosteroid users. There was some evidence of statistical heterogeneity for the subgroup analysis of setting, but when studies responsible for heterogeneity were removed there was no significant change to the result.
There was no evidence of publication bias.