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Fracture risk associated with systemic and topical corticosteroids
P Vestergaard1, L Rejnmark, L Mosekilde
1Department of Endocrinology and Metabolism C, Aarhus University Hospital, Aarhus, Denmark. p-vest@post4.tele.dk
Journal of Internal Medicine
|March 25, 2005
Summary
High doses of oral corticosteroids increase fracture risk. Inhaled corticosteroids pose a risk only at very high doses, while topical corticosteroids do not appear to increase fracture risk.
Area of Science:
- Pharmacology
- Bone Health
- Epidemiology
Background:
- Corticosteroids are widely used for their anti-inflammatory properties.
- Concerns exist regarding the potential skeletal side effects of corticosteroid use.
- Understanding formulation-specific fracture risks is crucial for patient safety.
Purpose of the Study:
- To investigate the association between corticosteroid use and fracture risk.
- To differentiate risks based on corticosteroid formulation and administration route.
Main Methods:
- A large community-based case-control study was conducted in Denmark.
- Fracture cases (n=124,655) were compared with age- and gender-matched controls (n=373,962).
- Statistical adjustments were made for confounding factors like comorbidities and other medications.
Main Results:
- Oral prednisolone exceeding 2.5 mg/day was linked to increased risk of any, hip, spine, and forearm fractures.
- Inhaled corticosteroids showed a slight increase in any fracture risk above 7.5 mg/day, but not for hip, spine, or forearm fractures.
- Various topical corticosteroids (dermal, rectal, nasal, etc.) did not demonstrate an increased fracture risk, even at high doses.
Conclusions:
- Daily oral corticosteroid doses over 2.5 mg are associated with elevated fracture risk.
- Inhaled corticosteroids are linked to increased fracture risk only at doses exceeding 7.5 mg/day.
- Topical corticosteroid formulations do not appear to elevate fracture risk.