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Fracture risk with intermittent high-dose oral glucocorticoid therapy

Fracture risk with intermittent high-dose oral glucocorticoid therapy
Fracture risk with intermittent high-dose oral glucocorticoid therapy
Objective: To evaluate the risk of fracture in patients receiving intermittent therapy with high-dose oral glucocorticoids (GCs).

Methods: The study group comprised 191,752 patients from the UK General Practice Database who were 40 years of age and older and received therapy with GCs. The followup time period was divided into the categories of current and no exposure. The daily dose and cumulative dose for each time period were determined. Relative risks were estimated using Cox proportional hazards models, adjusted for age, sex, body mass index, smoking, disease history, and drug history. Fractures of the radius/ulna, humerus, rib, femur/hip, pelvis, or vertebrae were included in the evaluation.

Results: Patients who intermittently received high-dose GCs (daily dose 15 mg) and had no or little previous exposure to GCs (cumulative exposure 1 gm) had a small increased risk of osteoporotic (but not hip/femur) fracture; this risk increased substantially with increasing cumulative exposure. Among patients who received a daily dose 30 mg and whose cumulative exposure was >5 gm, the relative risk (RR) of osteoporotic fracture was 3.63 (95% confidence interval [95% CI] 2.54-5.20), the RR of fracture of the hip/femur was 3.13 (95% CI 1.49-6.59), and the RR of vertebral fracture was 14.42 (95% CI 8.29-25.08).

Conclusion: Intermittent use of high-dose oral GCs (daily dose 15 mg and cumulative exposure 1 gm) may result in a small increased risk of osteoporotic fracture. Conversely, patients who receive several courses of high-dose GCs (daily dose 15 mg and cumulative exposure >1 gm) have a substantially increased risk of fracture.
0004-3591
208-214
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
Bracke, Madelon
d4eecf64-2f10-4913-9792-0b470bdce2bc
Leufkens, Hubert G.M.
299d1b54-3a02-48a9-9ffb-71ba2c3fa469
Lammers, Jan-Willem J.
ede3eba1-630a-4dd5-8c1f-55ee3c6a97f1
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Van Staa, Tjeerd P.
3e33e405-5ea6-4196-9693-7258f7fba8cb
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
Bracke, Madelon
d4eecf64-2f10-4913-9792-0b470bdce2bc
Leufkens, Hubert G.M.
299d1b54-3a02-48a9-9ffb-71ba2c3fa469
Lammers, Jan-Willem J.
ede3eba1-630a-4dd5-8c1f-55ee3c6a97f1
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Van Staa, Tjeerd P.
3e33e405-5ea6-4196-9693-7258f7fba8cb

de Vries, Frank, Bracke, Madelon, Leufkens, Hubert G.M., Lammers, Jan-Willem J., Cooper, Cyrus and Van Staa, Tjeerd P. (2007) Fracture risk with intermittent high-dose oral glucocorticoid therapy. Arthritis and Rheumatism, 56 (1), 208-214. (doi:10.1002/art.22294).

Record type: Article

Abstract

Objective: To evaluate the risk of fracture in patients receiving intermittent therapy with high-dose oral glucocorticoids (GCs).

Methods: The study group comprised 191,752 patients from the UK General Practice Database who were 40 years of age and older and received therapy with GCs. The followup time period was divided into the categories of current and no exposure. The daily dose and cumulative dose for each time period were determined. Relative risks were estimated using Cox proportional hazards models, adjusted for age, sex, body mass index, smoking, disease history, and drug history. Fractures of the radius/ulna, humerus, rib, femur/hip, pelvis, or vertebrae were included in the evaluation.

Results: Patients who intermittently received high-dose GCs (daily dose 15 mg) and had no or little previous exposure to GCs (cumulative exposure 1 gm) had a small increased risk of osteoporotic (but not hip/femur) fracture; this risk increased substantially with increasing cumulative exposure. Among patients who received a daily dose 30 mg and whose cumulative exposure was >5 gm, the relative risk (RR) of osteoporotic fracture was 3.63 (95% confidence interval [95% CI] 2.54-5.20), the RR of fracture of the hip/femur was 3.13 (95% CI 1.49-6.59), and the RR of vertebral fracture was 14.42 (95% CI 8.29-25.08).

Conclusion: Intermittent use of high-dose oral GCs (daily dose 15 mg and cumulative exposure 1 gm) may result in a small increased risk of osteoporotic fracture. Conversely, patients who receive several courses of high-dose GCs (daily dose 15 mg and cumulative exposure >1 gm) have a substantially increased risk of fracture.

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More information

Published date: 2007
Organisations: Dev Origins of Health & Disease

Identifiers

Local EPrints ID: 61051
URI: http://eprints.soton.ac.uk/id/eprint/61051
ISSN: 0004-3591
PURE UUID: ee595a83-a5cc-4c68-82d2-697597d50949
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 05 Sep 2008
Last modified: 18 Mar 2024 02:44

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Contributors

Author: Frank de Vries
Author: Madelon Bracke
Author: Hubert G.M. Leufkens
Author: Jan-Willem J. Lammers
Author: Cyrus Cooper ORCID iD
Author: Tjeerd P. Van Staa

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