Skeletal effects of systemic and topical corticosteroids

Area of Science:

• Pharmacology
• Bone Biology
• Endocrinology

Background:

• Oral corticosteroids (OCS) are linked to increased fracture risk due to adverse effects on bone metabolism, including sex steroids, vitamin D, and calcium balance.
• The fracture risk associated with OCS appears more dependent on the daily dose than the cumulative dose, with small daily doses potentially being more detrimental than intermittent high doses.

Purpose of the Study:

• To evaluate the association between different administration routes and dosages of corticosteroids and the risk of fractures.
• To compare the fracture risk posed by oral, topical, and inhaled corticosteroids.
• To explore strategies for mitigating corticosteroid-induced bone loss and fracture risk.

Main Methods:

• Review of existing literature and clinical data on corticosteroid use and fracture incidence.
• Analysis of the impact of daily versus cumulative dosing of oral corticosteroids on fracture risk.
• Comparison of fracture risks associated with topical and inhaled corticosteroid administration versus oral routes.

Main Results:

• Oral corticosteroids significantly increase fracture risk, with daily dosing being a more critical factor than cumulative exposure.
• Topical corticosteroids (ocular, aural, oral, dermal, rectal) are not associated with increased fracture risk.
• Inhaled corticosteroids are generally safe regarding fracture risk, except at very high doses exceeding typical therapeutic ranges.

Conclusions:

• Topical corticosteroid administration is preferable to oral routes for fracture prevention when clinically feasible.
• Further research is needed to develop intermittent dosing regimens for corticosteroids to maintain therapeutic benefits while reducing osteoporosis and fracture risks.