Table 31: Relative Risks for Fractures in People Receiving Corticosteroid Therapy Glucocorticoid*.
| Study | Type of Glucocorticoid Therapy |
RR vertebral fracture | RR non vertebral fracture | RR hip fracture |
|---|---|---|---|---|
| Kanis et al., 2004 (159) (Meta-analysis) | Ever use vs no use: RR for fractures: no significant difference between men and women | Any fracture (point estimate) Age 50: 1.98 Age 85: 1.66 All ages: 1.57 |
Osteoporotic fracture Age 50: 2.63 Age 85: 1.71 All ages: 1.66 |
Hip fracture Age 50: 4.42 Age 85: 2.48 All ages: 2.25 |
| Van Staa et al., 2000 (161) (Retrospective cohort) |
Oral 7.5mg vs 2.5mg | 2.83 (2.35–2.40) | 1.44(1.34–1.54) | 2.2(1.85–2.64) |
| Vestergaard et al., 2003 (160) (Prospective case controlled) |
Oral vs control 30mg for 4 days Short course of 450 mg7.5 mg/day × 6 months>1,500 mg |
Adjusted OR 0.96 (0.89–1.04) 1.17 (1.01–1.35) 1.36 (1.19–1.56) 1.65 (1.43–1.92) |
||
| Steinbuch et al., 2004 (162) (Retrospective cohort) |
Oral Overall Low dose<10 mg High dose>10 mg <90 days >90 days Test for trend significant P<0.01 – <.001 |
Adjusted 2.92 (2.0–4.3) 2.73 (1.80–4.15) 3.15 (2.07 –4.79) 2.88 (1.96–4.23) 3.27 (1.82–5.87) |
1.68 (1.5–1.9) 1.81 (1.61–2.04) 1.53 (1.35–1.74) 1.68 (1.51 –1.87) 1.69 (1.38–2.07) |
Adjusted 1.87 (1.2–2.9) 1.73 (1.04–2.90) 2.04 (1.22–3.41) 1.69 (1.06–2.70) 3.41 (1.72–6.75) |
| Vestergaard et al., 2005 163) (Prospective case controlled) |
Oral >2.5 mg Inhaled >7.5 mg |
Increased risk of any fracture, hip, spine, & forearm Limited increase in the risk of any fractures but no increased risk in hip, spine, or forearm fracture |
||
| Hubbard et al., 2006 164) (Retrospective cohort) |
Inhaled vs control | Any fracture Adjusted HR 2.53 (1.65–3.89) Trend P <.0001 Adjusted for oral corticosteroid HR 4.21 (2.19–8.13) |
||
| Donnan et al., 2005 (165) (Retrospective cohort) |
Inhaled vs general population | Women compared with men 5.19 (2.95–9.16) | All fractures adjusted 1.90 (1.68–2.16) | |
| Van Staa et al., 2001 (166) (Retrospective cohort) |
Inhaled vs control Inhaled vs bronchodilator |
1.51 (1.22–1.85) 1.00(0.94–1.06) |
1.15(1.10–1.20) | 1.22(1.04–1.43) |
| Hubbard et al., 2002 (167) (Case controlled) |
Inhaled vs control Inhaled vs control (adjusted) |
OR 1.26 (1.17–1.36) OR 1.19 (1.10–1.28) |
*
HR refers to hazard ratio; OR, odds ratio; RR, relative risk.
Adapted from J Bone Miner Res 2004; 19; 893-9 with permission of the American Society for Bone and Mineral Research