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

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Journal of Bone and Mineral Research

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

Excerpt:

Irrespective of the mechanism, these data indicate that the risk of all

fractures is substantially greater in corticosteroid-induced osteoporosis

than in postmenopausal osteoporosis for the same level of BMD. These

findings, derived from an international setting, have important practical

implications for intervention thresholds. Health economic analyses suggest

that intervention is cost-effective when treatment is targeted to women with

a T-score of −2.5 SD at the femoral neck.(27) Because exposure to

corticosteroids confers a risk over and above that provided by BMD,

intervention thresholds for BMD can be less stringent, at a T-score of

approximately −1.5 SD, and still yield the same cost-effectiveness. Such

thinking has now been incorporated into practice guidelines.(8,28)

The prevalence of corticosteroid use is relatively low, and the impact of

treating such patients with bone active agents on fracture burden in the

general community will not be great. Nevertheless, the strength of the

association is high, and the impact on individuals taking corticosteroids

will be high.

The full text of this article is here:

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

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org