Endocrinol Metab.  2020 Sep;35(3):562-570. 10.3803/EnM.2020.659.

Effects of Systemic Glucocorticoid Use on Fracture Risk: A Population-Based Study

• Koh JW
• Kim J
• Cho H
• Ha YC
• Kim TY
• Lee YK
• Kim HY
• Jang S

• KMID: 2508005
• DOI: http://doi.org/10.3803/EnM.2020.659

Abstract

Background
Long-term glucocorticoid use increases fracture risk by reducing bone mass. This study evaluated the relationship between hip and vertebral fractures and the total amount of systematic glucocorticoid use.
Methods
We randomly selected 1,896,159 people aged 20 to 100 years who participated in the National Health Checkup program in 2006. The amount of glucocorticoids prescribed was calculated based on the defined daily dose (DDD). The total DDD was obtained by adding oral and parenteral glucocorticoids for 6 months from the index date. Subjects were categorized into four groups according to total glucocorticoid DDDs: non-users (DDDs=0), low users (0< DDDs ≤45), intermediate users (45< DDDs ≤90), and high users (90< DDDs). We followed them for 2 years. A multivariate Cox proportional hazard model was used to evaluate the effects of the total amount of glucocorticoid use on hip and vertebral fractures.
Results
Higher glucocorticoid use was associated with a higher risk of vertebral fracture. Relative to non-users, the vertebral fracture risk was 1.39 times higher in the low-user group, 1.94 times higher in the intermediate-user group, and 2.43 times higher in the highuser group. The risk of hip fracture was 1.72 times higher in intermediate users and 3.28 times higher in high users than in non-users.
Conclusion
As the amount of glucocorticoid use for 6 months increased, the risk of hip and vertebral fractures became higher. In order to prevent fractures, it is necessary for doctors to evaluate the total amount of glucocorticoid prescribed to the patient and to provide appropriate treatment.

Keyword

Glucocorticoids; Fracture; Epidemiologic studies; Osteoporosis

Figure

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  Fig. 1 Selection of study subjects. GC, glucocorticoid; BMI, body mass index.

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  Fig. 2 Unadjusted incidence rate of vertebral and hip fracture by glucocorticoid (GC) amount the relationship between glucocorticoid exposure and fracture risk.

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  Fig. 3 Survival distribution function estimates for fracture. (A) Vertebral fracture. (B) Hip fracture.

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