RESEARCH - Fracture risk associated with different types of oral steroids and effect of termination of steroids on the risk of fractures

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Calcif Tissue Int. 2008 Apr;82(4):249-57. Epub 2008 Apr 15.

Fracture risk associated with different types of oral corticosteroids

and effect of termination of corticosteroids on the risk of fractures.

Vestergaard P, Rejnmark L, Mosekilde L.

The Osteoporosis Clinic, Aarhus Sygehus, Tage Hansens Gade 2, 8000,

Aarhus C, Denmark.

We conducted a case-control study on fracture risk associated with the

use of orally administered prednisolone/prednisone, budesonide,

methylprednisolone, and hydrocortisone to assess if the various

preparations were associated with different fracture patterns. Cases

were all subjects with any fracture sustained during the year 2000 (n

= 124,655). For each case, three controls (n = 373,962) matched on age

and gender were randomly drawn from the background population.

Adjustments were made for concurrent diseases, use of other drugs, and

a number of other factors. Oral prednisolone/prednisone was associated

with a dose-dependent increase in fracture risk starting from a dose

of around 6.7 mg/day. Oral budesonide was not associated with an

increase in overall fracture risk, but the doses in general were low

(<3 mg/day). Oral hydrocortisone was not associated with overall risk

of fractures. Oral methylprednisolone was only used intermittently and

was not associated with an increase in overall fracture risk at the

low doses used. After termination of oral prednisolone/prednisone, it

took more than 1 year for fracture risk to return to the levels of the

background population. Oral prednisolone is associated with a

dose-dependent increase in overall fracture risk. Budesonide at low

doses did not seem to be associated with fracture risk. Hydrocortisone

was not associated with an increase in the risk of fractures. It may

take a year from last use of prednisolone/prednisone before fracture

risk returns to that of the general population.

PMID: 18414920

http://www.ncbi.nlm.nih.gov/pubmed/18414920

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