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

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J Bone Miner Res. 2004 Jun;19(6):893-9. Epub 2004 Jan 27.

A meta-analysis of prior corticosteroid use and fracture risk.

Kanis JA, Johansson H, Oden A, ell O, de Laet C, Melton III LJ,

Tenenhouse A, Reeve J, Silman AJ, Pols HA, Eisman JA, McCloskey EV,

Mellstrom D.

Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of

Sheffield Medical School, Sheffield, United Kingdom.

W.J.Pontefract@...

The relationship between use of corticosteroids and fracture risk was

estimated in a meta-analysis of data from seven cohort studies of

approximately 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 beta 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. Copyright 2004 American Society for Bone and Mineral Research

PMID: 15125788

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15125788

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