Oral corticosteroids and fracture risk: relationship to daily and cumulative doses

Citation
Tp. Van Staa et al., Oral corticosteroids and fracture risk: relationship to daily and cumulative doses, RHEUMATOLOG, 39(12), 2000, pp. 1383-1389
Citations number
42
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Rheumatology
Journal title
RHEUMATOLOGY
ISSN journal
1462-0324 → ACNP
Volume
39
Issue
12
Year of publication
2000
Pages
1383 - 1389
Database
ISI
SICI code
1462-0324(200012)39:12<1383:OCAFRR>2.0.ZU;2-V
Abstract
Objective. This study examined the effects of daily and cumulative oral cor ticosteroid doses on the risk of fractures. Methods. Information was obtained from the General Practice Research Databa se, which contains medical records of general practitioners in England and Wales. The study included 244 235 oral corticosteroid users and 244 235 con trols. Results. Patients taking higher doses (at least 7.5 mg daily of prednisolon e or equivalent) had significantly increased risks of non-vertebral fractur e [relative rate (RR) = 1.44, 95% confidence interval (CI) 1.34-1.54], hip fracture (RR = 2.21, 95% CI 1.85-2.64) and vertebral fracture (RR = 2.83, 9 5% CI 2.35-2.40) relative to patients using oral corticosteroids at lower d oses (less than 2.5 mg per day). Fracture risk was also elevated among peop le with higher cumulative exposure to oral corticosteroids over the study p eriod, but this effect was almost wholly removed by adjustment for daily do se, age, gender and other confounding variables. Conclusions. These findings suggest that the adverse skeletal effects of or al corticosteroids manifest rapidly and are related to daily dose. The leve l of previous exposure to oral corticosteroids was not a strong determinant of the risk of fracture. Preventive measures against corticosteroid-induce d osteoporosis should therefore be instituted as soon after the commencemen t of glucocorticoid therapy as possible.