5-α Reductase Inhibitors and Risk of Hip Fracture

To the Editor: Dr Jacobsen and colleagues¹ studied the use of 5-α reductase inhibitors and the risk of hip fracture. There was exposure to finasteride in 1.5% of the cases and 2.0% of the controls before the index event. It would be helpful for the authors to clarify the duration that the patients were using finasteride before the index event.

It would also be interesting to know if the patients with hip fractures had been using long-term steroids, were smokers, used alcohol, had epilepsy, or had prior hip fractures, because these are associated with fracture incidence. We would also like to know if any of the patients with hip fractures had been screened for osteoporosis after the index event of the fracture. The study by Jacobsen et al recruited patients from 1997 to 2006, and during this period the updated American Urological Association guidelines² were released, recommending the use of 5-α reductase inhibitors over surgical intervention for treatment of benign prostatic hypertrophy with hematuria; this may have increased the total number of patients being treated with 5-α reductase inhibitors.