RESEARCH - A meta-analysis of prior steroid use and fracture risk

[Guest guest]

Journal of Bone and Mineral Research

June 2004:19:893-899 (doi: 10.1359/JBMR.040134)

A Meta-Analysis of Prior Corticosteroid Use and Fracture Risk

The relationship between use of corticosteroids and fracture risk was

estimated in a meta-analysis of data from seven cohort studies of 42,000 men

and women. Current and past use of corticosteroids was an important

predictor of fracture risk that was independent of prior fracture and BMD.

Introduction: The aims of this study were to validate that corticosteroid

use is a significant risk factor for fracture in an international setting

and to explore the effects of age and sex on this risk.

Materials and Methods: We studied 42,500 men and women from seven

prospectively studied cohorts followed for 176,000 patient-years. The

cohorts comprised the EPOS/EVOS study, CaMos, the Rotterdam Study, Dubbo

Osteoporosis Epidemiology Study (DOES), and prospective cohorts at

Sheffield, Rochester, and Gothenburg. The effect of ever use of

corticosteroids, BMD, age, and sex on all fracture, osteoporotic fracture,

and hip fracture risk alone was examined using Poisson regression in each

cohort and for each sex. The results of the different studies were merged

from the weighted β coefficients.

Results: Previous corticosteroid use was associated with a significantly

increased risk of any fracture, osteoporotic fracture, and hip fracture when

adjusted for BMD. Relative risk of any fracture ranged from 1.98 at the age

of 50 years to 1.66 at the age of 85 years. For osteoporotic fracture, the

range of relative risk was 2.63-1.71, and for hip fracture 4.42-2.48. The

estimate of relative risk was higher at younger ages, but not significantly

so. No significant difference in risk was seen between men and women. The

risk was marginally and not significantly upwardly adjusted when BMD was

excluded from the model. The risk was independent of prior fracture. In the

three cohorts that documented current corticosteroid use, BMD was

significantly reduced at the femoral neck, but fracture risk was still only

partly explained by BMD.

Conclusion: We conclude that prior and current exposure to corticosteroids

confers an increased risk of fracture that is of substantial importance

beyond that explained by the measurement of BMD. Its identification on an

international basis validates the use of this risk factor in case-finding

strategies.

Full text here:

http://www.jbmronline.org/doi/full/10.1359/JBMR.040134

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org