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Osteoporosis - preventing steroid-induced - Evidence
Evidence on corticosteroid use and risk of fracture
A meta-analysis indicates that corticosteroid use is associated with an increased relative risk of fracture that is independent of low bone mineral density (BMD).
- A meta-analysis of seven cohort studies (approximately n = 42,000 men and women) investigating current and past use of glucocorticoids on risk of fracture showed that previous corticosteroid use was associated with a significantly increased risk of any fracture, osteoporotic fracture, and hip fracture, when adjusted for BMD [Kanis et al, 2004]. The relative risk (RR) for:
- Any fracture: ranged from 1.98 (95% CI 1.35 to 2.92) at 50 years of age to 1.66 (95% CI 1.26 to 2.17) at 85 years of age.
- Osteoporotic fracture: ranged from 2.63 (95% CI 1.68 to 4.13) at 50 years of age to 1.71 (95% CI 1.29 to 2.28) at 85 years of age.
- Hip fracture: ranged from 4.42 (95% CI 1.26 to 15.49) at 50 years of age to 2.48 (95% CI 1.58 to 3.89) at 85 years of age.
- The RR was higher at younger ages, but not significantly. No significant difference in risk was seen between men and women.
- The risk was independent of prior fracture. In the three cohorts that documented current corticosteroid use, BMD was significantly reduced at the femoral neck, but fracture risk was still only partly explained by BMD.
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