- Clinical Study
- Effects of Systemic Glucocorticoid Use on Fracture Risk: A Population-Based Study
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Ji Weon Koh, Junkang Kim, Hyemin Cho, Yong-Chan Ha, Tae-Young Kim, Young-Kyun Lee, Ha Young Kim, Sunmee Jang
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Endocrinol Metab. 2020;35(3):562-570. Published online September 22, 2020
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DOI: https://doi.org/10.3803/EnM.2020.659
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 Abstract
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- 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.
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Citations
Citations to this article as recorded by  - Average daily glucocorticoid dose, number of prescription days, and cumulative dose in the initial 90 days of glucocorticoid therapy are associated with subsequent hip and clinical vertebral fracture risk: a retrospective cohort study using a nationwide h
Masayuki Iki, Kenji Fujimori, Shinichi Nakatoh, Junko Tamaki, Shigeyuki Ishii, Nobukazu Okimoto, Hironori Imano, Sumito Ogawa
Osteoporosis International.2024; 35(5): 805. CrossRef - Low-dose glucocorticoid increase the risk of fracture in postmenopausal women with low bone mass: a retrospective cohort study
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Sarah J. Billups, Vinh K Thai, Jacob Denkins, Ian C. Dettman, Micol S. Rothman
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Madhuni Herath, Bente Langdahl, Peter R. Ebeling, Frances Milat
Clinical Endocrinology.2022; 96(4): 460. CrossRef - Comparative effectiveness of bisphosphonate treatments for the prevention of re-fracture in glucocorticoid-induced osteoporosis: protocol for a systematic review and meta-analysis
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BMJ Open.2022; 12(9): e062537. CrossRef - Why Do We Need Proactive Management for Fracture Prevention in Long-Term Glucocorticoid Users?
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