BACKGROUND: Animal studies have demonstrated that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) increase bone formation and bone volume. Although studies in humans suggest that statins may increase bone formation, no research has been done to determine whether older persons taking these drugs will have a decreased risk of fracture.

POPULATION STUDIED: The study used data from the United Kingdom-based General Practice Research Database, which includes information from approximately 300 general practices. The base population consisted of more than 91,000 individuals aged 50 to 89 years. Of these, more than 28,000 had received at least 1 prescription for a lipid-lowering drug for hyperlipidemia, approximately 13,000 had hyperlipidemia but were not taking lipid-lowering agents, and 50,000 were randomly selected patients without a diagnosis of hyperlipidemia. Patients were excluded if they had a diagnosis of osteoporosis, osteomalacia, malignancy, alcoholism, or if they were taking bisphosphonates. A total of 3940 patients who had a bone fracture were identified by the International Classification of Diseases-eighth revision (ICD-8) and were verified by hospital discharge records or referral letters to specialists. These case patients were matched for age, sex, practice attended, calendar year, and years enrolled to 23,379 control group patients from the base population who had not had a fracture.

STUDY DESIGN AND VALIDITY: This was a large population-based case-control study nested within an ongoing study. Members of the 3 groups were followed until they developed a fracture, left the practice, or died. Patients taking a lipid-lowering drug were categorized as being current users, recent users, and past users.

OUTCOMES MEASURED: The primary outcome was the risk of development of a first-time fracture of the femur, humerus, hand, wrist, lower arm, clavicle, vertebral body, foot, or other unspecified fracture among the 3 groups as estimated by the odds ratio. The authors used statistical analysis (logistic regression) to consider the type, timing, and duration of treatment as estimated by numbers of prescriptions filled.

RESULTS: After adjusting for variables including smoking status, weight, hormone replacement therapy or corticosteroid use, and the number of office visits before the fracture, patients who had any current or recent recorded prescriptions for statins before the date of fracture had a significantly lowered risk of fracture with adjusted odds ratios of 0.55 for current users (95% confidence interval [CI], 0.44-0.69) and 0.67 (95% CI, 0.50-0.92) for recent users of statins. The odds ratio for previous users of statins was not statistically significant. A consistent class effect was noted, with all statins associated with decreased fracture risk. Other lipid-lowering agents were not associated with a reduced risk for fracture. The effect of statins on risk of fracture did not differ by the skeletal site of fracture, age group, or sex.

BACKGROUND: Animal studies have demonstrated that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) increase bone formation and bone volume. Although studies in humans suggest that statins may increase bone formation, no research has been done to determine whether older persons taking these drugs will have a decreased risk of fracture.

POPULATION STUDIED: The study used data from the United Kingdom-based General Practice Research Database, which includes information from approximately 300 general practices. The base population consisted of more than 91,000 individuals aged 50 to 89 years. Of these, more than 28,000 had received at least 1 prescription for a lipid-lowering drug for hyperlipidemia, approximately 13,000 had hyperlipidemia but were not taking lipid-lowering agents, and 50,000 were randomly selected patients without a diagnosis of hyperlipidemia. Patients were excluded if they had a diagnosis of osteoporosis, osteomalacia, malignancy, alcoholism, or if they were taking bisphosphonates. A total of 3940 patients who had a bone fracture were identified by the International Classification of Diseases-eighth revision (ICD-8) and were verified by hospital discharge records or referral letters to specialists. These case patients were matched for age, sex, practice attended, calendar year, and years enrolled to 23,379 control group patients from the base population who had not had a fracture.

STUDY DESIGN AND VALIDITY: This was a large population-based case-control study nested within an ongoing study. Members of the 3 groups were followed until they developed a fracture, left the practice, or died. Patients taking a lipid-lowering drug were categorized as being current users, recent users, and past users.

OUTCOMES MEASURED: The primary outcome was the risk of development of a first-time fracture of the femur, humerus, hand, wrist, lower arm, clavicle, vertebral body, foot, or other unspecified fracture among the 3 groups as estimated by the odds ratio. The authors used statistical analysis (logistic regression) to consider the type, timing, and duration of treatment as estimated by numbers of prescriptions filled.

RESULTS: After adjusting for variables including smoking status, weight, hormone replacement therapy or corticosteroid use, and the number of office visits before the fracture, patients who had any current or recent recorded prescriptions for statins before the date of fracture had a significantly lowered risk of fracture with adjusted odds ratios of 0.55 for current users (95% confidence interval [CI], 0.44-0.69) and 0.67 (95% CI, 0.50-0.92) for recent users of statins. The odds ratio for previous users of statins was not statistically significant. A consistent class effect was noted, with all statins associated with decreased fracture risk. Other lipid-lowering agents were not associated with a reduced risk for fracture. The effect of statins on risk of fracture did not differ by the skeletal site of fracture, age group, or sex.

BACKGROUND: Animal studies have demonstrated that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) increase bone formation and bone volume. Although studies in humans suggest that statins may increase bone formation, no research has been done to determine whether older persons taking these drugs will have a decreased risk of fracture.

POPULATION STUDIED: The study used data from the United Kingdom-based General Practice Research Database, which includes information from approximately 300 general practices. The base population consisted of more than 91,000 individuals aged 50 to 89 years. Of these, more than 28,000 had received at least 1 prescription for a lipid-lowering drug for hyperlipidemia, approximately 13,000 had hyperlipidemia but were not taking lipid-lowering agents, and 50,000 were randomly selected patients without a diagnosis of hyperlipidemia. Patients were excluded if they had a diagnosis of osteoporosis, osteomalacia, malignancy, alcoholism, or if they were taking bisphosphonates. A total of 3940 patients who had a bone fracture were identified by the International Classification of Diseases-eighth revision (ICD-8) and were verified by hospital discharge records or referral letters to specialists. These case patients were matched for age, sex, practice attended, calendar year, and years enrolled to 23,379 control group patients from the base population who had not had a fracture.

STUDY DESIGN AND VALIDITY: This was a large population-based case-control study nested within an ongoing study. Members of the 3 groups were followed until they developed a fracture, left the practice, or died. Patients taking a lipid-lowering drug were categorized as being current users, recent users, and past users.

OUTCOMES MEASURED: The primary outcome was the risk of development of a first-time fracture of the femur, humerus, hand, wrist, lower arm, clavicle, vertebral body, foot, or other unspecified fracture among the 3 groups as estimated by the odds ratio. The authors used statistical analysis (logistic regression) to consider the type, timing, and duration of treatment as estimated by numbers of prescriptions filled.

RESULTS: After adjusting for variables including smoking status, weight, hormone replacement therapy or corticosteroid use, and the number of office visits before the fracture, patients who had any current or recent recorded prescriptions for statins before the date of fracture had a significantly lowered risk of fracture with adjusted odds ratios of 0.55 for current users (95% confidence interval [CI], 0.44-0.69) and 0.67 (95% CI, 0.50-0.92) for recent users of statins. The odds ratio for previous users of statins was not statistically significant. A consistent class effect was noted, with all statins associated with decreased fracture risk. Other lipid-lowering agents were not associated with a reduced risk for fracture. The effect of statins on risk of fracture did not differ by the skeletal site of fracture, age group, or sex.

BACKGROUND: Asthma remains a leading cause of hospitalization in children. It has been determined that the MDI is equally as effective as nebulized wet aerosol therapy for treatment of acute asthma in adults, and may even work better in children older than 2 years.¹ The authors of this study investigated whether the same relationship holds true in children between the ages of 10 months and 4 years.

POPULATION STUDIED: The investigators enrolled 42 children aged 10 months to 4 years presenting to the emergency department of a large hospital in Israel. Children were not included if they had a history of cardiac disease or chronic respiratory disease (other than asthma), had an altered level of consciousness, or were in respiratory failure. Most subjects were referred from their primary care physicians to the emergency department because of the severity of their presentation.

STUDY DESIGN AND VALIDITY: This study was a randomized controlled double-blind double-dummy clinical trial. Subjects were randomly assigned to 2 groups. Randomization assignment was concealed. The first group received a standard dose of salbutamol (2.5 mg in 1.5 cc of normal saline) by nebulized aerosol therapy along with 4 puffs of placebo by MDI with a spacing device and facemask. The second group received 4 puffs of salbutamol (400 μg) by MDI with spacer and facemask along with 2 mL of normal saline by nebulized aerosol. Clinical scores (respiratory rate, pulse rate, pulse oximetry, wheezing, breath sounds, and retractions) were calculated at baseline and also 15 minutes after the conclusion of each respiratory treatment. Each patient received a total of 3 treatments delivered at 20-minute intervals. The study is well designed. The authors do not mention if any treatments were rendered by the referring physicians before arrival in the emergency department. The presence of antecedent b-agonist therapy could have affected the outcomes. This study was large enough to find a difference in the major outcomes (if one exists) but not to determine whether MDI therapy results in a change in the rate of hospitalization.

OUTCOMES MEASURED: The 2 major outcomes were respiratory rate and the patient’s clinical score. Minor outcomes included pulse rate and room air pulse oximetry. Hospitalization rates between the groups were also compared.

RESULTS: The study groups were similar at baseline. The reduction in respiratory rate and the improvement in patients’ clinical scores were similar between groups. Side effect rates were similar in the 2 groups. A total of 31% required hospitalization, but there was no difference in the rate of hospitalization between groups.

BACKGROUND: Asthma remains a leading cause of hospitalization in children. It has been determined that the MDI is equally as effective as nebulized wet aerosol therapy for treatment of acute asthma in adults, and may even work better in children older than 2 years.¹ The authors of this study investigated whether the same relationship holds true in children between the ages of 10 months and 4 years.

POPULATION STUDIED: The investigators enrolled 42 children aged 10 months to 4 years presenting to the emergency department of a large hospital in Israel. Children were not included if they had a history of cardiac disease or chronic respiratory disease (other than asthma), had an altered level of consciousness, or were in respiratory failure. Most subjects were referred from their primary care physicians to the emergency department because of the severity of their presentation.

STUDY DESIGN AND VALIDITY: This study was a randomized controlled double-blind double-dummy clinical trial. Subjects were randomly assigned to 2 groups. Randomization assignment was concealed. The first group received a standard dose of salbutamol (2.5 mg in 1.5 cc of normal saline) by nebulized aerosol therapy along with 4 puffs of placebo by MDI with a spacing device and facemask. The second group received 4 puffs of salbutamol (400 μg) by MDI with spacer and facemask along with 2 mL of normal saline by nebulized aerosol. Clinical scores (respiratory rate, pulse rate, pulse oximetry, wheezing, breath sounds, and retractions) were calculated at baseline and also 15 minutes after the conclusion of each respiratory treatment. Each patient received a total of 3 treatments delivered at 20-minute intervals. The study is well designed. The authors do not mention if any treatments were rendered by the referring physicians before arrival in the emergency department. The presence of antecedent b-agonist therapy could have affected the outcomes. This study was large enough to find a difference in the major outcomes (if one exists) but not to determine whether MDI therapy results in a change in the rate of hospitalization.

OUTCOMES MEASURED: The 2 major outcomes were respiratory rate and the patient’s clinical score. Minor outcomes included pulse rate and room air pulse oximetry. Hospitalization rates between the groups were also compared.

RESULTS: The study groups were similar at baseline. The reduction in respiratory rate and the improvement in patients’ clinical scores were similar between groups. Side effect rates were similar in the 2 groups. A total of 31% required hospitalization, but there was no difference in the rate of hospitalization between groups.

BACKGROUND: Asthma remains a leading cause of hospitalization in children. It has been determined that the MDI is equally as effective as nebulized wet aerosol therapy for treatment of acute asthma in adults, and may even work better in children older than 2 years.¹ The authors of this study investigated whether the same relationship holds true in children between the ages of 10 months and 4 years.

POPULATION STUDIED: The investigators enrolled 42 children aged 10 months to 4 years presenting to the emergency department of a large hospital in Israel. Children were not included if they had a history of cardiac disease or chronic respiratory disease (other than asthma), had an altered level of consciousness, or were in respiratory failure. Most subjects were referred from their primary care physicians to the emergency department because of the severity of their presentation.

STUDY DESIGN AND VALIDITY: This study was a randomized controlled double-blind double-dummy clinical trial. Subjects were randomly assigned to 2 groups. Randomization assignment was concealed. The first group received a standard dose of salbutamol (2.5 mg in 1.5 cc of normal saline) by nebulized aerosol therapy along with 4 puffs of placebo by MDI with a spacing device and facemask. The second group received 4 puffs of salbutamol (400 μg) by MDI with spacer and facemask along with 2 mL of normal saline by nebulized aerosol. Clinical scores (respiratory rate, pulse rate, pulse oximetry, wheezing, breath sounds, and retractions) were calculated at baseline and also 15 minutes after the conclusion of each respiratory treatment. Each patient received a total of 3 treatments delivered at 20-minute intervals. The study is well designed. The authors do not mention if any treatments were rendered by the referring physicians before arrival in the emergency department. The presence of antecedent b-agonist therapy could have affected the outcomes. This study was large enough to find a difference in the major outcomes (if one exists) but not to determine whether MDI therapy results in a change in the rate of hospitalization.

OUTCOMES MEASURED: The 2 major outcomes were respiratory rate and the patient’s clinical score. Minor outcomes included pulse rate and room air pulse oximetry. Hospitalization rates between the groups were also compared.

RESULTS: The study groups were similar at baseline. The reduction in respiratory rate and the improvement in patients’ clinical scores were similar between groups. Side effect rates were similar in the 2 groups. A total of 31% required hospitalization, but there was no difference in the rate of hospitalization between groups.