Increased Exposure to Corticosteroids Could Increase Fracture Risk

New research from a team at the University of Nottingham has uncovered a link between increased exposure to corticosteroids and a greater risk of osteoporosis and fragility fractures in older patients.

Results of the study concluded there was a dose-response relationship between cumulative dose of either oral or inhaled corticosteroid exposure with an increased risk of osteoporosis or fragility fracture.

“Our findings provide evidence that both oral corticosteroid and inhaled corticosteroid exposure have deleterious effects on bone health. We found a clear dose-response relationship, with higher cumulative doses and number of oral corticosteroid and inhaled corticosteroid prescriptions being associated with increased odds of osteoporosis and fragility fractures. The percentage of patients receiving bisphosphonates after oral corticosteroid initiation was low,” wrote investigators.

With previous data detailing potential adverse effects associated with increased corticoid exposure use, a trio of investigators from the University of Nottingham sought to determine whether these therapies were associated with an increased risk of osteoporosis and fragility fractures. The current analysis was designed with the aim of assessing these associations in a comparison of a pair of nested case-control studies using data from the Clinical Practice Research Datalink and Hospital Episode Statistics databases.

For inclusion in their study, investigators required patients to be at least 18 years of age and have a Read code for asthma between April 2004-December 2017. Patients were also required to have at least 1 year of data collection prior to the diagnosis of asthma. Using the aforementioned databases, investigators identified cases defined by the first-record diagnosis of osteoporosis or fragility fractures.

For the purpose of the analysis, investigators examined the year prior to index date to determine exposure status to oral or inhaled corticosteroids. Investigators also queried information related to the use of bisphosphonate, which investigators pointed are recommended for patients to prevent the loss of bone density. Of note, fragility fractures were defined as a composite of vertebral, hip, forearm-wrist, and humeral fractures.

Upon analysis, results indicated a dose-response relationship between both the cumulative dose and number of oral corticosteroids and inhaled corticosteroids within the previous year and risk of osteoporosis or fragility fractures. In adjusted models, those receiving more oral corticosteroid prescriptions had a 4.5 (95% CI, 3.21-6.11) and 2.16 (95% CI, 1.56-3.32) times greater odds of osteoporosis and fragility fractures, respectively. Similarly, those receiving more inhaled corticosteroid was associated with 1.60 (95% CI, 1.22-2.10) and 1.31 (95% CI, 1.02-1.68) times greater odds of osteoporosis and fragility fractures, respectively.

Despite guidelines recommending use, results also suggested the rate of patients receiving 9 or more oral corticosteroid prescriptions and at least a single bisphosphonate prescription was just 50.6% and 48.4% for osteoporosis and fragility fractures, respectively.

“The use of OCS and ICS should be kept to the minimum necessary to treat symptoms and should be stepped down if symptoms and exacerbations are well managed. Bisphosphonate comedication should be considered according to guidelines for bone protection,” investigators wrote.

This study, “Risk of osteoporosis and fragility fractures in asthma due to oral and inhaled corticosteroids: two population-based nested case-control studies,” was published in Asthma.