FRACTURE RISK ASSOCIATED WITH ORAL CORTICOSTEROID USE: A RETROSPECTIVE COHORT STUDY ON DOSE-RESPONSE AND THE REVERSIBILITY OF FRACTURE RISK POST-THERAPY
Main Article Content
Keywords
: Oral corticosteroids, fracture risk, osteoporosis, vertebral fracture, proximal femur
Abstract
The use of oral corticosteroids is also common in the management of different inflammatory and autoimmune diseases accompanied by a high fracture rate in vertebral body and proximal femur. This paper was a prospective retrospective cohort study that tried to assess the risks of fractures in patients who were exposed to oral corticosteroids based on the 250 general practices in the United Kingdom. The research has identified that the risk of fractures increases significantly very soon after corticosteroid therapy is initiated and it directly depends upon the dose of corticosteroids. It is worth noting that the risk of fractures reduced to baseline levels once corticosteroid therapy was stopped with the highest degree in subsequent 12 months. These data imply that it might be crucial to pay attention to the risk of fractures in patients who are treated with high doses of corticosteroids and that early detection of corticosteroid-induced osteoporosis could be valuable. Future research is required to increase knowledge of long-term effects due to corticosteroid usage in relation to the development of fracture and the importance of early preventative efforts.
References
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34. Sambrook, P. N. (1996). Corticosteroid-induced osteoporosis. Journal of Rheumatology, 23(Suppl 45), 19–22.
35. Dequeker, J., & Westhovens, R. (1995). Low dose corticosteroid-associated osteoporosis in rheumatoid arthritis and its prophylaxis and treatment: Bones of contention. Journal of Rheumatology, 22(5), 1013–1019.
36. Lufkin, E. G., Wahner, H. W., Bergstralh, E. J., & Bilezikian, J. P. (1988). Reversibility of steroid-induced osteoporosis. American Journal of Medicine, 85(6), 887–888.
37. Hermus, A. R., Huysmans, A., Smals, A. G., Corstens, F. H., Kloppenborg, P. W., & van 't Hof, M. A. (1994). Remarkable improvement of osteopenia after cure of Cushing's syndrome. Hormone and Metabolic Research, 26(5), 209–210.
38. Manning, P. J., Evans, M. C., & Reid, I. R. (1992). Normal bone mineral density following cure of Cushing's syndrome. Clinical Endocrinology, 36(2), 229–234.
39. Pocock, N. A., Eisman, J. A., Dunstan, C. R., Evans, R. A., Thomas, D. H., & Huq, N. L. (1987). Recovery from steroid-induced osteoporosis. Annals of Internal Medicine, 107(3), 319–323.
40. Laan, R. F. J. M., van Riel, P. L. C. M., van de Putte, L. B. A., van Erning, L. J. T. O., van 't Hof, M. A., & Lemmens, J. A. M. (1993). Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis. Annals of Internal Medicine, 119(12), 963–968.
41. Hall, G. H., Spector, T. D., Griffin, A. J., Jawad, A. S. M., Hall, M. L., & Doyle, D. V. (1993). The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthritis and Rheumatism, 36(10), 1510–1516.
42. Rizzato, G., & Montemurro, L. (1993). Reversibility of exogenous corticosteroid-induced bone loss. European Respiratory Journal, 6(1), 116–119.
43. Anonymous. (1996). The EPIC Encyclopedia of Clinical Practice. EPIC, The GP Database Research Company.
44. Donaldson, L. J., Cook, A., & Thomson, R. G. (1990). Incidence of fractures in a geographically defined population. Journal of Epidemiology and Community Health, 44(4), 241–245.
2. Reid, I. R. (1998). Glucocorticoid-induced osteoporosis: Other forms of secondary osteoporosis. In P. J. Meunier (Ed.), Osteoporosis: Diagnosis and Management (pp. 233–250). Martin Dunitz.
3. Luengo, M., Picado, C., Del Rio, L., Guañabens, N., Montserrat, J. M., & Setoain, J. (1991). Vertebral fractures in steroid-dependent asthma and involutional osteoporosis: A comparative study. Thorax, 46(10), 803–806.
4. Cooper, C., Coupland, C., & Mitchell, M. (1995). Rheumatoid arthritis, corticosteroid therapy, and hip fracture. Annals of the Rheumatic Diseases, 54(1), 49–52.
5. Hooyman, J. R., Melton, J. L., III, Nelson, A. M., O'Fallon, M. W., & Riggs, B. L. (1984). Fractures after rheumatoid arthritis. Arthritis & Rheumatism, 27(12), 1353–1361.
6. Hall, G. (1992). Pharmacoepidemiology using a UK database of primary care records. Pharmacoepidemiology and Drug Safety, 1(1), 33–37.
7. Lis, Y., & Mann, R. D. (1995). The VAMP research multi-purpose database in the U.K. Journal of Clinical Epidemiology, 48(5), 431–443.
8. Mann, R. D., Hall, G., & Chukwujindu, I. (1992). Research implications of computerized primary care. Post Marketing Surveillance, 5(5), 259–268.
9. Hollowell, J. (1994). General Practice Research Database (GPRD): Scope and Quality of Data. Office of Population Censuses and Statistics.
10. Anonymous. (1996). The General Practice Research Database: Information for Researchers. Office for National Statistics.
11. Walley, T., & Mantgani, A. (1997). The U.K. General Practice Research Database. Lancet, 350(9090), 1097–1099.
12. Jick, H., Jick, S. S., & Derby, L. E. (1991). Validation of information recorded on general practitioner-based computerized data resource in the United Kingdom. British Medical Journal, 302(6779), 766–768.
13. Jick, H., Terris, B. Z., Derby, L. E., & Jick, S. S. (1992). Further validation of information recorded on a general practitioner-based computerized data resource in the United Kingdom. Pharmacoepidemiology and Drug Safety, 1(5), 347–349.
14. Nazareth, I., King, M., Haines, A., Rangel, L., & Myers, S. (1993). Accuracy of diagnosis of psychosis on general practice computer system. British Medical Journal, 307(6895), 32–34.
15. van Staa, T. P., & Abenhaim, L. (1994). The quality of information recorded on a U.K. database of primary care records: A study of hospitalization due to hypoglycemia and other conditions. Pharmacoepidemiology and Drug Safety, 3(1), 15–21.
16. Shane, E. (1996). Osteoporosis associated with illness and medications. In R. Marcus, D. Feldman, & J. Kelsey (Eds.), Osteoporosis (pp. 925–946). Academic Press.
17. Grisso, J. A., Capezuti, E., & Schwartz, A. (1996). Falls as risk factors for fractures. In R. Marcus, D. Feldman, & J. Kelsey (Eds.), Osteoporosis (pp. 599–611). Academic Press.
18. British Medical Association & the Royal Pharmaceutical Society of Great Britain. (1996). British National Formulary Number 32 (September 1996). Pharmaceutical Press.
19. Breslow, N. E., & Day, N. E. (1987). Statistical Methods in Cancer Research. International Agency for Research on Cancer.
20. Greenland, S. (1989). Modelling and variable selection in epidemiologic analysis. American Journal of Public Health, 79(3), 340–349.
21. Greenland, S. (1995). Dose-response and trend analysis in epidemiology: Alternatives to categorical analysis. Epidemiology, 6(4), 356–365.
22. Durrleman, S., & Simon, R. (1989). Flexible regression models with cubic splines. Statistics in Medicine, 8(5), 551–561.
23. Pizer, S. M. (1975). Numerical Computing and Mathematical Analysis (Chapter 4). Science Research Associates, Inc.
24. Anonymous. (1996). SAS/GRAPH Software: Reference, version 6, 1st ed., Vol. 1. SAS Institute, Inc.
25. McDougall, R., Sibley, J., Haga, M., & Russell, A. (1994). Outcome in patients with rheumatoid arthritis receiving prednisone compared to matched controls. Journal of Rheumatology, 21(7), 1207–1213.
26. Saag, K. G., Koehnke, R., Caldwell, J. R., Brasington, R., Burmeister, L. F., Zimmerman, B., Kohler, J. A., & Furst, D. E. (1994). Low dose long-term corticosteroid therapy in rheumatoid arthritis: An analysis of serious adverse events. American Journal of Medicine, 96(2), 115–123.
27. Michel, B. A., Bloch, D. A., & Fries, J. F. (1991). Predictors of fractures in early rheumatoid arthritis. Journal of Rheumatology, 18(6), 804–809.
28. Michel, B. A., Bloch, D. A., Wolfe, F., & Fries, J. F. (1993). Fractures in rheumatoid arthritis: An evaluation of associated risk factors. Journal of Rheumatology, 20(10), 1666–1669.
29. Adinoff, A. D., Hollister, M. D., & Roger, J. (1983). Steroid-induced fractures and bone loss in patients with asthma. New England Journal of Medicine, 309(5), 265–268.
30. Weinstein, R. S., Jilka, R. L., Parfitt, A. M., & Manolagas, S. C. (1998). Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Journal of Clinical Investigation, 102(2), 274–282.
31. Cummings, S. R., Black, D. M., & Vogt, T. M., for the FIT Research Group. (1996). Changes in BMD substantially underestimate the anti-fracture effects of alendronate and other antiresorptive drugs. Journal of Bone and Mineral Research, 11(Suppl 1), 102.
32. Shane, E., Rivas, M. D. C., Silverberg, S. J., Kim, T. S., Staron, R. B., & Bilezikian, J. P. (1993). Osteoporosis after cardiac transplantation. American Journal of Medicine, 94(3), 257–264.
33. Sambrook, P. N., & Jones, G. (1995). Corticosteroid osteoporosis. British Journal of Rheumatology, 34(1), 8–12.
34. Sambrook, P. N. (1996). Corticosteroid-induced osteoporosis. Journal of Rheumatology, 23(Suppl 45), 19–22.
35. Dequeker, J., & Westhovens, R. (1995). Low dose corticosteroid-associated osteoporosis in rheumatoid arthritis and its prophylaxis and treatment: Bones of contention. Journal of Rheumatology, 22(5), 1013–1019.
36. Lufkin, E. G., Wahner, H. W., Bergstralh, E. J., & Bilezikian, J. P. (1988). Reversibility of steroid-induced osteoporosis. American Journal of Medicine, 85(6), 887–888.
37. Hermus, A. R., Huysmans, A., Smals, A. G., Corstens, F. H., Kloppenborg, P. W., & van 't Hof, M. A. (1994). Remarkable improvement of osteopenia after cure of Cushing's syndrome. Hormone and Metabolic Research, 26(5), 209–210.
38. Manning, P. J., Evans, M. C., & Reid, I. R. (1992). Normal bone mineral density following cure of Cushing's syndrome. Clinical Endocrinology, 36(2), 229–234.
39. Pocock, N. A., Eisman, J. A., Dunstan, C. R., Evans, R. A., Thomas, D. H., & Huq, N. L. (1987). Recovery from steroid-induced osteoporosis. Annals of Internal Medicine, 107(3), 319–323.
40. Laan, R. F. J. M., van Riel, P. L. C. M., van de Putte, L. B. A., van Erning, L. J. T. O., van 't Hof, M. A., & Lemmens, J. A. M. (1993). Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis. Annals of Internal Medicine, 119(12), 963–968.
41. Hall, G. H., Spector, T. D., Griffin, A. J., Jawad, A. S. M., Hall, M. L., & Doyle, D. V. (1993). The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthritis and Rheumatism, 36(10), 1510–1516.
42. Rizzato, G., & Montemurro, L. (1993). Reversibility of exogenous corticosteroid-induced bone loss. European Respiratory Journal, 6(1), 116–119.
43. Anonymous. (1996). The EPIC Encyclopedia of Clinical Practice. EPIC, The GP Database Research Company.
44. Donaldson, L. J., Cook, A., & Thomson, R. G. (1990). Incidence of fractures in a geographically defined population. Journal of Epidemiology and Community Health, 44(4), 241–245.
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Dec 20, 2021
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Dr. Anil Kumar Muthineni. (2021). FRACTURE RISK ASSOCIATED WITH ORAL CORTICOSTEROID USE: A RETROSPECTIVE COHORT STUDY ON DOSE-RESPONSE AND THE REVERSIBILITY OF FRACTURE RISK POST-THERAPY. Journal of Population Therapeutics and Clinical Pharmacology, 28(2), 1206-1213. https://doi.org/10.53555/22stae90
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Author Biography
Dr. Anil Kumar Muthineni
Associate Professor, Department of General Medicine, Sri Lakshmi Narayana Institute of Medical Sciences & Hospital, Osudu, Agaram Village, Koodapakkam Post, Puducherry - 605502
How to Cite
Dr. Anil Kumar Muthineni. (2021). FRACTURE RISK ASSOCIATED WITH ORAL CORTICOSTEROID USE: A RETROSPECTIVE COHORT STUDY ON DOSE-RESPONSE AND THE REVERSIBILITY OF FRACTURE RISK POST-THERAPY. Journal of Population Therapeutics and Clinical Pharmacology, 28(2), 1206-1213. https://doi.org/10.53555/22stae90
