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The Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, employing authors Frank de Vries and Patrick Souverein, has received unrestricted funding for pharmacoepidemiological research from GlaxoSmithKline, Novo Nordisk, priDear Sir, In a recent publication on the effects of carvedilol and low-turnover bone disease, Dr. Goto and colleagues have cited our work [1, 2] . They wrote that ‘we have suggested that use of beta-blockers is associated with a reduced risk of fractures’ [1] . We are afraid that this does not reflect the key finding of this study: although we observed a small inverse association between beta-blocker use and risk of hip/femur fracture in Dutch and British patients, it is unlikely that this effect was causal: ‘the effect was constant with cumulative dose and the odds ratio [between beta-blocker use and hip/femur fracture risk, FV] was below 1.0, even among patients who had just started treatment with beta-blockers. As the mechanism by which beta-blockers could influence BMD is likely to need Published online: December 24, 2011

Interpretation of the Association between Beta-Blockers and Hip/Femur Fracture