2023-08-21 03:19:00
To minimize the fracture side effects of corticosteroids, a study has found that focus should be placed on duration rather than dose.
In the case of short and thick one-time use, the risk of fracture increased and the frequency of taking osteoporosis drugs increased compared to those who were consistently prescribed a similar cumulative dose.
The results of a study on the risk of fracture by corticosteroid use and dose, conducted by researchers including Julian Matthewman of the London School of Hygiene and Tropical Medicine, UK, were published in the international journal JAMA on the 9th (doi:10.1001/jamadermatol.2023.2495). ).
As a result of cohort analysis of the London School of Hygiene and Tropical Medicine in the UK, the duration of steroid administration has an effect on the risk of fracture.
Steroids are widely prescribed as effective anti-inflammatory agents in chronic inflammatory diseases. Steroids begin to lose bone within a few weeks of administration, increasing the risk of fracture, so short-term prescription is recommended for eczema, asthma, and COPD, except for rheumatoid arthritis.
It has been known that the cumulative steroid dose is the largest factor in the decrease in bone density and the risk of fracture, but it has not been confirmed whether the total number of days of administration affects the risk.
Focusing on the fact that the elderly are vulnerable to the risk of steroid-induced fractures, the research team focused on cumulative administration of 450 mg of Prednisolone for a short period of time (high-intensity group), and when 5 mg or more daily was administered over a relatively long time or divided into several times (low-intensity group). We analyzed whether there was a change in fracture risk.
A total of 93,869 patients with eczema, asthma, or COPD (UK cohort 65,195, Canada cohort 28,674) aged 66 years or older who took cumulative oral prednisolone ≥ 450 mg within 6 months for fracture prevention according to increased fracture risk Prescription medications and rates of major osteoporotic fractures were compared.
As a result of risk analysis using a Cox proportional hazards regression model, the risk of receiving fracture prevention treatment was up to twice as high in the high-intensity group who received short-term oral corticosteroids once (UK cohort HR 2.34, Canadian cohort 1.49).
However, the rates of major osteoporotic fractures in both the high- and low-intensity groups were similar (UK HR 1.07, Canada 0.87).
“Previous studies have looked at the association between oral corticosteroid prescribing patterns and fracture risk, but no study has investigated the association with cumulative doses,” the researchers said. Compared to the high-intensity group, the risk of receiving fracture prevention treatment was reduced by half.”
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