BONE MINERAL DENSITY CHANGES AND INCREASED FRACTURE RISK IN PATIENTS UNDERGOING LONG-TERM CORTICOSTEROID THERAPY: A RETROSPECTIVE COHORT STUDY
Main Article Content
Keywords
Bone mineral density, corticosteroid-induced osteoporosis, fracture risk, long-term therapy, bisphosphonates, preventive measures
Abstract
Introduction: Corticosteroids have found a wide application for the treatment of inflammatory and autoimmune conditions. Thus, in their turn, the long-term use is connected with the negative effect on the bones, their mineralization and increased probability of fractures. Such information is very useful in the process of designing preventive and controlling measures.
Aim: This study sought to assess the degree of BMD changes and fracture risk in patients who received long-term corticosteroid therapy, as well as the factors associated with the changes and potential interventions taken to prevent further deterioration.
Methodology: The study design used in the present investigation was a retrospective cohort analysis from the records of Ayub Teaching Hospital, Abbottabad, Pakistan from 2010 to 2020. Participants were the patients aged 18 to 75 years who had received corticosteroids for at least 6 months. Lumbar spine and femoral neck BMD alterations were measured by DEXA. Data on fractures were studied by Kaplan-Meier survival curves and cox proportional hazards models.
Results: A total of 520 patients (mean age: 56. These patients (mean age = 59; 61.5% female and 38.5% male, Mean disease duration of 3 years) were included. Lumbar spine BMD was reduced by 10.7% and femoral neck BMD by 14.5%. Fracture prevalence was 15%, vertebral being the most frequent (48.7%) followed by hip (38.5%). They found that relevant clinical risk factors included use of high corticosteroids dose over 10 mg/day, duration of corticosteroids therapy of over twelve months, postmenopausal status and poor body mass index less than 20 kg/m². Bisphosphonates were protective in significantly preventing both further losses in BMD by 43.5% and fractures by 38.7%.
Conclusion: Chronic corticosteroid use adversely affects bone mass and increases the risk for fractures and falls in afflicted individuals and vulnerable groups. These results provide support for more effective administrations in order to enhance patient results.
Aim: This study sought to assess the degree of BMD changes and fracture risk in patients who received long-term corticosteroid therapy, as well as the factors associated with the changes and potential interventions taken to prevent further deterioration.
Methodology: The study design used in the present investigation was a retrospective cohort analysis from the records of Ayub Teaching Hospital, Abbottabad, Pakistan from 2010 to 2020. Participants were the patients aged 18 to 75 years who had received corticosteroids for at least 6 months. Lumbar spine and femoral neck BMD alterations were measured by DEXA. Data on fractures were studied by Kaplan-Meier survival curves and cox proportional hazards models.
Results: A total of 520 patients (mean age: 56. These patients (mean age = 59; 61.5% female and 38.5% male, Mean disease duration of 3 years) were included. Lumbar spine BMD was reduced by 10.7% and femoral neck BMD by 14.5%. Fracture prevalence was 15%, vertebral being the most frequent (48.7%) followed by hip (38.5%). They found that relevant clinical risk factors included use of high corticosteroids dose over 10 mg/day, duration of corticosteroids therapy of over twelve months, postmenopausal status and poor body mass index less than 20 kg/m². Bisphosphonates were protective in significantly preventing both further losses in BMD by 43.5% and fractures by 38.7%.
Conclusion: Chronic corticosteroid use adversely affects bone mass and increases the risk for fractures and falls in afflicted individuals and vulnerable groups. These results provide support for more effective administrations in order to enhance patient results.
References
1. Adler, R. A., & Hochberg, M. C. (2019). Managing osteoporosis in patients on long-term glucocorticoid therapy. Rheumatic Disease Clinics of North America, 45(3), 473–490.
2. Adachi, J. D., et al. (2000). Efficacy of alendronate for the prevention of corticosteroid-induced osteoporosis. The New England Journal of Medicine, 343(5), 292–299.
3. Compston, J. (2018). Glucocorticoid-induced osteoporosis: An update. Endocrine, 61(1), 7–16.
4. De Nijs, R. N. J., et al. (2012). Increased fracture risk in patients with inflammatory bowel disease and corticosteroid use. Osteoporosis International, 23(4), 1575–1583.
5. Kanis, J. A., et al. (2004). A meta-analysis of the efficacy of corticosteroids on fracture risk. Osteoporosis International, 15(3), 200–207.
6. Overman, R. A., et al. (2013). Long-term effects of glucocorticoid therapy on bone mineral density. Journal of Clinical Endocrinology & Metabolism, 98(2), 132–140.
7. Saag, K. G., et al. (2017). Denosumab versus risedronate in glucocorticoid-induced osteoporosis. The Lancet Diabetes & Endocrinology, 5(11), 901–910.
8. Sambrook, P. N., et al. (2006). Preventing corticosteroid-induced osteoporosis: A meta-analysis. Journal of Bone and Mineral Research, 21(1), 117–123.
9. Van Staa, T. P., et al. (2002). Corticosteroids and fracture risk. The Journal of Bone and Joint Surgery, 84(8), 1198–1203.
10. Weinstein, R. S. (2011). Glucocorticoid-induced osteoporosis and osteonecrosis. Endocrinology and Metabolism Clinics of North America, 41(3), 595–611.
11. Adachi, J. D., et al. (2000). Efficacy of alendronate for the prevention of corticosteroid-induced osteoporosis. The New England Journal of Medicine, 343(5), 292–299.
12. Adler, R. A., & Hochberg, M. C. (2019). Managing osteoporosis in patients on long-term glucocorticoid therapy. Rheumatic Disease Clinics of North America, 45(3), 473–490.
13. Compston, J. (2018). Glucocorticoid-induced osteoporosis: An update. Endocrine, 61(1), 7–16.
14. De Nijs, R. N. J., et al. (2012). Increased fracture risk in patients with inflammatory bowel disease and corticosteroid use. Osteoporosis International, 23(4), 1575–1583.
15. Kanis, J. A., et al. (2004). A meta-analysis of the efficacy of corticosteroids on fracture risk. Osteoporosis International, 15(3), 200–207.
16. NIH Osteoporosis and Related Bone Diseases National Resource Center. (2021). Osteoporosis prevention and management. NIH Publications.
17. Overman, R. A., et al. (2013). Long-term effects of glucocorticoid therapy on bone mineral density. Journal of Clinical Endocrinology & Metabolism, 98(2), 132–140.
18. Saag, K. G., et al. (2017). Denosumab versus risedronate in glucocorticoid-induced osteoporosis. The Lancet Diabetes & Endocrinology, 5(11), 901–910.
19. Sambrook, P. N., et al. (2006). Preventing corticosteroid-induced osteoporosis: A meta-analysis. Journal of Bone and Mineral Research, 21(1), 117–123.
20. Van Staa, T. P., et al. (2002). Corticosteroids and fracture risk. The Journal of Bone and Joint Surgery, 84(8), 1198–1203.
21. Weinstein, R. S. (2011). Glucocorticoid-induced osteoporosis and osteonecrosis. Endocrinology and Metabolism Clinics of North America, 41(3), 595–611.
22. Adler, R. A., & Hochberg, M. C. (2019). Managing osteoporosis in patients on long-term glucocorticoid therapy. Rheumatic Disease Clinics of North America, 45(3), 473–490.
23. Compston, J. (2018). Glucocorticoid-induced osteoporosis: An update. Endocrine, 61(1), 7–16.
24. Kanis, J. A., et al. (2020). The impact of long-term corticosteroid use on bone health. Osteoporosis International, 31(12), 2281–2290.
25. NIH Osteoporosis and Related Bone Diseases National Resource Center. (2021). Osteoporosis prevention and management. NIH Publications.
2. Adachi, J. D., et al. (2000). Efficacy of alendronate for the prevention of corticosteroid-induced osteoporosis. The New England Journal of Medicine, 343(5), 292–299.
3. Compston, J. (2018). Glucocorticoid-induced osteoporosis: An update. Endocrine, 61(1), 7–16.
4. De Nijs, R. N. J., et al. (2012). Increased fracture risk in patients with inflammatory bowel disease and corticosteroid use. Osteoporosis International, 23(4), 1575–1583.
5. Kanis, J. A., et al. (2004). A meta-analysis of the efficacy of corticosteroids on fracture risk. Osteoporosis International, 15(3), 200–207.
6. Overman, R. A., et al. (2013). Long-term effects of glucocorticoid therapy on bone mineral density. Journal of Clinical Endocrinology & Metabolism, 98(2), 132–140.
7. Saag, K. G., et al. (2017). Denosumab versus risedronate in glucocorticoid-induced osteoporosis. The Lancet Diabetes & Endocrinology, 5(11), 901–910.
8. Sambrook, P. N., et al. (2006). Preventing corticosteroid-induced osteoporosis: A meta-analysis. Journal of Bone and Mineral Research, 21(1), 117–123.
9. Van Staa, T. P., et al. (2002). Corticosteroids and fracture risk. The Journal of Bone and Joint Surgery, 84(8), 1198–1203.
10. Weinstein, R. S. (2011). Glucocorticoid-induced osteoporosis and osteonecrosis. Endocrinology and Metabolism Clinics of North America, 41(3), 595–611.
11. Adachi, J. D., et al. (2000). Efficacy of alendronate for the prevention of corticosteroid-induced osteoporosis. The New England Journal of Medicine, 343(5), 292–299.
12. Adler, R. A., & Hochberg, M. C. (2019). Managing osteoporosis in patients on long-term glucocorticoid therapy. Rheumatic Disease Clinics of North America, 45(3), 473–490.
13. Compston, J. (2018). Glucocorticoid-induced osteoporosis: An update. Endocrine, 61(1), 7–16.
14. De Nijs, R. N. J., et al. (2012). Increased fracture risk in patients with inflammatory bowel disease and corticosteroid use. Osteoporosis International, 23(4), 1575–1583.
15. Kanis, J. A., et al. (2004). A meta-analysis of the efficacy of corticosteroids on fracture risk. Osteoporosis International, 15(3), 200–207.
16. NIH Osteoporosis and Related Bone Diseases National Resource Center. (2021). Osteoporosis prevention and management. NIH Publications.
17. Overman, R. A., et al. (2013). Long-term effects of glucocorticoid therapy on bone mineral density. Journal of Clinical Endocrinology & Metabolism, 98(2), 132–140.
18. Saag, K. G., et al. (2017). Denosumab versus risedronate in glucocorticoid-induced osteoporosis. The Lancet Diabetes & Endocrinology, 5(11), 901–910.
19. Sambrook, P. N., et al. (2006). Preventing corticosteroid-induced osteoporosis: A meta-analysis. Journal of Bone and Mineral Research, 21(1), 117–123.
20. Van Staa, T. P., et al. (2002). Corticosteroids and fracture risk. The Journal of Bone and Joint Surgery, 84(8), 1198–1203.
21. Weinstein, R. S. (2011). Glucocorticoid-induced osteoporosis and osteonecrosis. Endocrinology and Metabolism Clinics of North America, 41(3), 595–611.
22. Adler, R. A., & Hochberg, M. C. (2019). Managing osteoporosis in patients on long-term glucocorticoid therapy. Rheumatic Disease Clinics of North America, 45(3), 473–490.
23. Compston, J. (2018). Glucocorticoid-induced osteoporosis: An update. Endocrine, 61(1), 7–16.
24. Kanis, J. A., et al. (2020). The impact of long-term corticosteroid use on bone health. Osteoporosis International, 31(12), 2281–2290.
25. NIH Osteoporosis and Related Bone Diseases National Resource Center. (2021). Osteoporosis prevention and management. NIH Publications.
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Published
May 15, 2021
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How to Cite
Dr. Muhammad Shoaib Zardad, Dr. Muhammad Younas, Dr. Syed Usman Shah, Dr. Abid Ur Rehman, Dr. Muhammad Ali Usman, & Dr. Baber Shahzad Sadiq. (2021). BONE MINERAL DENSITY CHANGES AND INCREASED FRACTURE RISK IN PATIENTS UNDERGOING LONG-TERM CORTICOSTEROID THERAPY: A RETROSPECTIVE COHORT STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 28(2), 672-683. https://doi.org/10.53555/yqaqq775
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Author Biographies
Dr. Muhammad Shoaib Zardad
Assistant Professor, Ayub Medical College, Abbottabad, Pakistan
Dr. Muhammad Younas
Assistant Professor, Ayub Medical College, Abbottabad, Pakistan
Dr. Syed Usman Shah
Assistant Professor, Ayub Medical College, Abbottabad, Pakistan
Dr. Abid Ur Rehman
Assistant Professor, Ayub Medical College, Abbottabad, Pakistan
Dr. Muhammad Ali Usman
Assistant Professor, Abbottabad International Medical Institute, Abbottabad, Pakistan
Dr. Baber Shahzad Sadiq
Consultant Orthopaedic Surgeon, Ayub Teaching Hospital, Abbottabad, Pakistan
How to Cite
Dr. Muhammad Shoaib Zardad, Dr. Muhammad Younas, Dr. Syed Usman Shah, Dr. Abid Ur Rehman, Dr. Muhammad Ali Usman, & Dr. Baber Shahzad Sadiq. (2021). BONE MINERAL DENSITY CHANGES AND INCREASED FRACTURE RISK IN PATIENTS UNDERGOING LONG-TERM CORTICOSTEROID THERAPY: A RETROSPECTIVE COHORT STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 28(2), 672-683. https://doi.org/10.53555/yqaqq775