Determining causation—A case study: Adrenocorticosteroids and osteoporosis Should the fear of inducing clinically important osteoporosis influence the decision to prescribe adrenocorticosteroids?

It is generally accepted that exogenous adrenocorticosteroids cause clinically important osteoporosis. We have reviewed the evidence regarding causation in two stages: an examination of the strength of the methods used, and an application of five "diagnostic tests" for causation. The methods that have been used to investigate the association are weak: there have been no randomized clinical trials or prospective cohort studies. The measures of …