Influence of recency and duration of glucocorticoid use on bone mineral density and risk of fractures: population-based cohort study
Summary Although systemic glucocorticoids are commonly used, it is difficult to obtain accurate exposure history. In 50,000 patients, we confirmed that glucocorticoids were associated with reductions in bone mineral density (BMD) and increases in fracture and documented that recent and prolonged dur...
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| Veröffentlicht in: | Osteoporosis international 2013-09, Vol.24 (9), p.2493-2498 |
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| creator | Majumdar, S. R. Morin, S. N. Lix, L. M. Leslie, W. D. |
| description | Summary
Although systemic glucocorticoids are commonly used, it is difficult to obtain accurate exposure history. In 50,000 patients, we confirmed that glucocorticoids were associated with reductions in bone mineral density (BMD) and increases in fracture and documented that recent and prolonged durations of exposure were particularly associated with adverse events—dose information did not improve risk prediction.
Introduction
Systemic glucocorticoid use, defined as ever having taken supra-physiologic doses for 90-days or more, is a risk factor for low BMD and fractures. This definition does not distinguish recent (vs remote) exposure.
Methods
Within a population-based clinical BMD registry in Manitoba, Canada, we identified all adults over age 40 years tested between 1998 and 2007 and then undertook a cohort study. We identified all oral glucocorticoid dispensations from 1995 to 2009 and stratified exposure by timing (“recent” if within 12 months vs “remote”) and duration (short [ |
| doi_str_mv | 10.1007/s00198-013-2352-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1434036916</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3040120601</sourcerecordid><originalsourceid>FETCH-LOGICAL-c405t-aab8cd20eb765477393a681b659ea366b75df50de97b65d610bebfdb155c6e6b3</originalsourceid><addsrcrecordid>eNp1kTtvHCEUhVFkK14_foCbCMlNmolhGGBJF1mJY8mSG1tyh3jcWc96FjYwFNv7h5vN2FEUKRVw-c65V_cgdE7JF0qIvMyEULVsCGVNy3jbsA9oQTtWX0rwA7QgislGdfTxCB3nvCZVo5T8iI4qLVvatQv0chP6sUBwgGOPE7h63WETPPYlmWmIYV9fjcVFF9M0uDh4XHKlA7YxAN4MAZIZsYeQh2mWpiE_72V9Mm4qCfJXvI3bMv72a6zJ4LGLT9UP56n43Sk67M2Y4eztPEEPP77fX_1sbu-ub66-3TauI3xqjLFL51sCVgreSckUM2JJreAKDBPCSu57TjwoWWteUGLB9t5Szp0AYdkJ-jz7blP8VSBPejNkB-NoAsSSdd1dR5hQVFT04h90HUsKdbpK0aVoRatkpehMuRRzTtDrbRo2Ju00JXofkZ4j0jUivY9Is6r59OZc7Ab8H8V7JhVoZyDXr7CC9Ffr_7q-AmZmnhM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1418626297</pqid></control><display><type>article</type><title>Influence of recency and duration of glucocorticoid use on bone mineral density and risk of fractures: population-based cohort study</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Majumdar, S. R. ; Morin, S. N. ; Lix, L. M. ; Leslie, W. D.</creator><creatorcontrib>Majumdar, S. R. ; Morin, S. N. ; Lix, L. M. ; Leslie, W. D.</creatorcontrib><description>Summary
Although systemic glucocorticoids are commonly used, it is difficult to obtain accurate exposure history. In 50,000 patients, we confirmed that glucocorticoids were associated with reductions in bone mineral density (BMD) and increases in fracture and documented that recent and prolonged durations of exposure were particularly associated with adverse events—dose information did not improve risk prediction.
Introduction
Systemic glucocorticoid use, defined as ever having taken supra-physiologic doses for 90-days or more, is a risk factor for low BMD and fractures. This definition does not distinguish recent (vs remote) exposure.
Methods
Within a population-based clinical BMD registry in Manitoba, Canada, we identified all adults over age 40 years tested between 1998 and 2007 and then undertook a cohort study. We identified all oral glucocorticoid dispensations from 1995 to 2009 and stratified exposure by timing (“recent” if within 12 months vs “remote”) and duration (short [<90 days] vs prolonged [≥90 days]). Osteoporosis-related risk factors and treatments and major fractures were obtained using administrative health data.
Results
A total of 12,818 of 52,070 (25 %) subjects had used glucocorticoids prior to BMD testing; the most common exposure was remote short (
n
= 6453) vs recent prolonged (
n
= 2896) vs recent short (
n
= 2644) vs remote prolonged (
n
= 825). Compared to 39,252 never-users, only recent prolonged glucocorticoid use was significantly associated with femoral neck T-score (ANCOVA-adjusted difference −0.13, 95 % CI −0.16 to −0.10,
p
< 0.001). There were 2,842 major (566 hip) fractures over median 5-year follow-up. Compared with never-users, only recent prolonged glucocorticoid use was significantly associated with BMD-independent increases in risk of incident major fracture (5.4 vs 7.7 %, adjusted HR 1.25, 95 % CI 1.07–1.45,
p
= 0.004) and hip fracture (1.1 vs 1.8 %, adjusted HR 1.61, 95 % CI 1.18–2.20,
p
= 0.003).
Conclusions
Recent and prolonged glucocorticoid use (but neither remote nor recent short courses) was independently associated with reduced BMD and increased risk of fractures. These findings should permit clinicians to identify a high-risk group of patients that might benefit from osteoporosis prevention.</description><identifier>ISSN: 0937-941X</identifier><identifier>EISSN: 1433-2965</identifier><identifier>DOI: 10.1007/s00198-013-2352-3</identifier><identifier>PMID: 23572142</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Absorptiometry, Photon ; Administration, Oral ; Adult ; Aged ; Bone density ; Bone Density - drug effects ; Cohort Studies ; Drug Administration Schedule ; Endocrinology ; Female ; Femur Neck - physiopathology ; Fractures ; Glucocorticoids - administration & dosage ; Glucocorticoids - adverse effects ; Humans ; Incidence ; Lumbar Vertebrae - physiopathology ; Male ; Manitoba - epidemiology ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Orthopedics ; Osteoporosis - chemically induced ; Osteoporosis - epidemiology ; Osteoporosis - physiopathology ; Osteoporotic Fractures - chemically induced ; Osteoporotic Fractures - epidemiology ; Osteoporotic Fractures - physiopathology ; Registries ; Rheumatology ; Risk Factors ; Steroids</subject><ispartof>Osteoporosis international, 2013-09, Vol.24 (9), p.2493-2498</ispartof><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-aab8cd20eb765477393a681b659ea366b75df50de97b65d610bebfdb155c6e6b3</citedby><cites>FETCH-LOGICAL-c405t-aab8cd20eb765477393a681b659ea366b75df50de97b65d610bebfdb155c6e6b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00198-013-2352-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00198-013-2352-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23572142$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Majumdar, S. R.</creatorcontrib><creatorcontrib>Morin, S. N.</creatorcontrib><creatorcontrib>Lix, L. M.</creatorcontrib><creatorcontrib>Leslie, W. D.</creatorcontrib><title>Influence of recency and duration of glucocorticoid use on bone mineral density and risk of fractures: population-based cohort study</title><title>Osteoporosis international</title><addtitle>Osteoporos Int</addtitle><addtitle>Osteoporos Int</addtitle><description>Summary
Although systemic glucocorticoids are commonly used, it is difficult to obtain accurate exposure history. In 50,000 patients, we confirmed that glucocorticoids were associated with reductions in bone mineral density (BMD) and increases in fracture and documented that recent and prolonged durations of exposure were particularly associated with adverse events—dose information did not improve risk prediction.
Introduction
Systemic glucocorticoid use, defined as ever having taken supra-physiologic doses for 90-days or more, is a risk factor for low BMD and fractures. This definition does not distinguish recent (vs remote) exposure.
Methods
Within a population-based clinical BMD registry in Manitoba, Canada, we identified all adults over age 40 years tested between 1998 and 2007 and then undertook a cohort study. We identified all oral glucocorticoid dispensations from 1995 to 2009 and stratified exposure by timing (“recent” if within 12 months vs “remote”) and duration (short [<90 days] vs prolonged [≥90 days]). Osteoporosis-related risk factors and treatments and major fractures were obtained using administrative health data.
Results
A total of 12,818 of 52,070 (25 %) subjects had used glucocorticoids prior to BMD testing; the most common exposure was remote short (
n
= 6453) vs recent prolonged (
n
= 2896) vs recent short (
n
= 2644) vs remote prolonged (
n
= 825). Compared to 39,252 never-users, only recent prolonged glucocorticoid use was significantly associated with femoral neck T-score (ANCOVA-adjusted difference −0.13, 95 % CI −0.16 to −0.10,
p
< 0.001). There were 2,842 major (566 hip) fractures over median 5-year follow-up. Compared with never-users, only recent prolonged glucocorticoid use was significantly associated with BMD-independent increases in risk of incident major fracture (5.4 vs 7.7 %, adjusted HR 1.25, 95 % CI 1.07–1.45,
p
= 0.004) and hip fracture (1.1 vs 1.8 %, adjusted HR 1.61, 95 % CI 1.18–2.20,
p
= 0.003).
Conclusions
Recent and prolonged glucocorticoid use (but neither remote nor recent short courses) was independently associated with reduced BMD and increased risk of fractures. These findings should permit clinicians to identify a high-risk group of patients that might benefit from osteoporosis prevention.</description><subject>Absorptiometry, Photon</subject><subject>Administration, Oral</subject><subject>Adult</subject><subject>Aged</subject><subject>Bone density</subject><subject>Bone Density - drug effects</subject><subject>Cohort Studies</subject><subject>Drug Administration Schedule</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Femur Neck - physiopathology</subject><subject>Fractures</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Glucocorticoids - adverse effects</subject><subject>Humans</subject><subject>Incidence</subject><subject>Lumbar Vertebrae - physiopathology</subject><subject>Male</subject><subject>Manitoba - epidemiology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Osteoporosis - chemically induced</subject><subject>Osteoporosis - epidemiology</subject><subject>Osteoporosis - physiopathology</subject><subject>Osteoporotic Fractures - chemically induced</subject><subject>Osteoporotic Fractures - epidemiology</subject><subject>Osteoporotic Fractures - physiopathology</subject><subject>Registries</subject><subject>Rheumatology</subject><subject>Risk Factors</subject><subject>Steroids</subject><issn>0937-941X</issn><issn>1433-2965</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kTtvHCEUhVFkK14_foCbCMlNmolhGGBJF1mJY8mSG1tyh3jcWc96FjYwFNv7h5vN2FEUKRVw-c65V_cgdE7JF0qIvMyEULVsCGVNy3jbsA9oQTtWX0rwA7QgislGdfTxCB3nvCZVo5T8iI4qLVvatQv0chP6sUBwgGOPE7h63WETPPYlmWmIYV9fjcVFF9M0uDh4XHKlA7YxAN4MAZIZsYeQh2mWpiE_72V9Mm4qCfJXvI3bMv72a6zJ4LGLT9UP56n43Sk67M2Y4eztPEEPP77fX_1sbu-ub66-3TauI3xqjLFL51sCVgreSckUM2JJreAKDBPCSu57TjwoWWteUGLB9t5Szp0AYdkJ-jz7blP8VSBPejNkB-NoAsSSdd1dR5hQVFT04h90HUsKdbpK0aVoRatkpehMuRRzTtDrbRo2Ju00JXofkZ4j0jUivY9Is6r59OZc7Ab8H8V7JhVoZyDXr7CC9Ffr_7q-AmZmnhM</recordid><startdate>20130901</startdate><enddate>20130901</enddate><creator>Majumdar, S. R.</creator><creator>Morin, S. N.</creator><creator>Lix, L. M.</creator><creator>Leslie, W. D.</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>20130901</creationdate><title>Influence of recency and duration of glucocorticoid use on bone mineral density and risk of fractures: population-based cohort study</title><author>Majumdar, S. R. ; Morin, S. N. ; Lix, L. M. ; Leslie, W. D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c405t-aab8cd20eb765477393a681b659ea366b75df50de97b65d610bebfdb155c6e6b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Absorptiometry, Photon</topic><topic>Administration, Oral</topic><topic>Adult</topic><topic>Aged</topic><topic>Bone density</topic><topic>Bone Density - drug effects</topic><topic>Cohort Studies</topic><topic>Drug Administration Schedule</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Femur Neck - physiopathology</topic><topic>Fractures</topic><topic>Glucocorticoids - administration & dosage</topic><topic>Glucocorticoids - adverse effects</topic><topic>Humans</topic><topic>Incidence</topic><topic>Lumbar Vertebrae - physiopathology</topic><topic>Male</topic><topic>Manitoba - epidemiology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Osteoporosis - chemically induced</topic><topic>Osteoporosis - epidemiology</topic><topic>Osteoporosis - physiopathology</topic><topic>Osteoporotic Fractures - chemically induced</topic><topic>Osteoporotic Fractures - epidemiology</topic><topic>Osteoporotic Fractures - physiopathology</topic><topic>Registries</topic><topic>Rheumatology</topic><topic>Risk Factors</topic><topic>Steroids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Majumdar, S. R.</creatorcontrib><creatorcontrib>Morin, S. N.</creatorcontrib><creatorcontrib>Lix, L. M.</creatorcontrib><creatorcontrib>Leslie, W. D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>Osteoporosis international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Majumdar, S. R.</au><au>Morin, S. N.</au><au>Lix, L. M.</au><au>Leslie, W. D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of recency and duration of glucocorticoid use on bone mineral density and risk of fractures: population-based cohort study</atitle><jtitle>Osteoporosis international</jtitle><stitle>Osteoporos Int</stitle><addtitle>Osteoporos Int</addtitle><date>2013-09-01</date><risdate>2013</risdate><volume>24</volume><issue>9</issue><spage>2493</spage><epage>2498</epage><pages>2493-2498</pages><issn>0937-941X</issn><eissn>1433-2965</eissn><abstract>Summary
Although systemic glucocorticoids are commonly used, it is difficult to obtain accurate exposure history. In 50,000 patients, we confirmed that glucocorticoids were associated with reductions in bone mineral density (BMD) and increases in fracture and documented that recent and prolonged durations of exposure were particularly associated with adverse events—dose information did not improve risk prediction.
Introduction
Systemic glucocorticoid use, defined as ever having taken supra-physiologic doses for 90-days or more, is a risk factor for low BMD and fractures. This definition does not distinguish recent (vs remote) exposure.
Methods
Within a population-based clinical BMD registry in Manitoba, Canada, we identified all adults over age 40 years tested between 1998 and 2007 and then undertook a cohort study. We identified all oral glucocorticoid dispensations from 1995 to 2009 and stratified exposure by timing (“recent” if within 12 months vs “remote”) and duration (short [<90 days] vs prolonged [≥90 days]). Osteoporosis-related risk factors and treatments and major fractures were obtained using administrative health data.
Results
A total of 12,818 of 52,070 (25 %) subjects had used glucocorticoids prior to BMD testing; the most common exposure was remote short (
n
= 6453) vs recent prolonged (
n
= 2896) vs recent short (
n
= 2644) vs remote prolonged (
n
= 825). Compared to 39,252 never-users, only recent prolonged glucocorticoid use was significantly associated with femoral neck T-score (ANCOVA-adjusted difference −0.13, 95 % CI −0.16 to −0.10,
p
< 0.001). There were 2,842 major (566 hip) fractures over median 5-year follow-up. Compared with never-users, only recent prolonged glucocorticoid use was significantly associated with BMD-independent increases in risk of incident major fracture (5.4 vs 7.7 %, adjusted HR 1.25, 95 % CI 1.07–1.45,
p
= 0.004) and hip fracture (1.1 vs 1.8 %, adjusted HR 1.61, 95 % CI 1.18–2.20,
p
= 0.003).
Conclusions
Recent and prolonged glucocorticoid use (but neither remote nor recent short courses) was independently associated with reduced BMD and increased risk of fractures. These findings should permit clinicians to identify a high-risk group of patients that might benefit from osteoporosis prevention.</abstract><cop>London</cop><pub>Springer London</pub><pmid>23572142</pmid><doi>10.1007/s00198-013-2352-3</doi><tpages>6</tpages></addata></record> |
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| ispartof | Osteoporosis international, 2013-09, Vol.24 (9), p.2493-2498 |
| issn | 0937-941X 1433-2965 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Absorptiometry, Photon Administration, Oral Adult Aged Bone density Bone Density - drug effects Cohort Studies Drug Administration Schedule Endocrinology Female Femur Neck - physiopathology Fractures Glucocorticoids - administration & dosage Glucocorticoids - adverse effects Humans Incidence Lumbar Vertebrae - physiopathology Male Manitoba - epidemiology Medicine Medicine & Public Health Middle Aged Original Article Orthopedics Osteoporosis - chemically induced Osteoporosis - epidemiology Osteoporosis - physiopathology Osteoporotic Fractures - chemically induced Osteoporotic Fractures - epidemiology Osteoporotic Fractures - physiopathology Registries Rheumatology Risk Factors Steroids |
| title | Influence of recency and duration of glucocorticoid use on bone mineral density and risk of fractures: population-based cohort study |
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