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| |  DG DISPATCH - WCO: Dose, Pattern, and Duration of Oral Corticosteroid Treatment Affect Osteoporosis Risk By W. A. Thomasson, PhD Special to DG News
CHICAGO, IL -- June 17, 2000 -- Although oral corticosteroid use inevitably increases bone fragility, the severity of the effect -- at least in terms of fracture risk -- can be modified by the dose, pattern of use (continuous versus intermittent), and duration of steroid use. This was the major conclusion of a paper presented yesterday (June 16) by Dr. M. Steinbuch, of Mason, OH, at the World Congress on Osteoporosis. The authors drew their data from an health maintenance organisation (HMO) claims database, and included everyone aged 18 to 64 years who received a glucocorticoid prescription in 1995 or 1996. Researchers examined these subjects' claim data from a year before the claim until a fracture occurred, the subjects withdrew from the plan (at least one year after prescription), or the study ended in December 1997. A control group was matched for age, sex, and date of first pharmacy claim. The analysis included 17,957 oral glucocorticoid users and an equal number of control individuals. Analyses were adjusted for the difference in prior fracture history between glucocorticoid-exposed and control groups. On an adjusted bases, glucocorticoid use increased the risk of fracture between two- and three-fold. Users of high-dose corticosteroids were at significantly greater risk than were low-dose users. For vertebral fracture, the relative risks were 3.2 and 2.2, respectively. Likewise, long-term (at least 90-day) use was associated with greater risk than short-term use. Continuous use, defined as use at least 80 percent of the time between first and last prescriptions, also carried a higher fracture risk than intermittent or one-time use. Continuous users were 3.3 times as likely as control subjects to have a vertebral fracture, while vertebral fracture risk in long-term intermittent users was only twice that of control individuals. "The relationship between dose, duration, and patters of [glucocorticoid] exposure and the risk of fracture is emerging, and should be considered in clinical practice in an effort to avoid the debilitating effects of fractures in glucocorticoid-induced osteoporosis patients," Dr. Steinbuch concluded.
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