Fracture risk in oral glucocorticoid users: a Bayesian meta-regression leveraging control arms of osteoporosis clinical trials

Amiche, Mohamed; Albaum, Jordan M.; Tadrous, Mina; Pechlivanoglou, Petros; Lévesque, Linda E.; Adachi, Jonathan D.; Cadarette, Suzanne M.

doi:10.1007/s00198-015-3455-9

Cited by 110 publications

(84 citation statements)

References 42 publications

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“…We confirmed in our sample, femoral bone density impacts more deeply than vertebral T-score and/or BMD on bone strenght, as it is less affected by any interferences (52). We interestingly found the presence of previous osteoporotic fragility fractures and chronic glucocorticoids therapy should especially negatively influence bone health of our patients.…”

Section: Resultssupporting

confidence: 68%

“…FRAX score calculated to estimate 10-year probability for femoral fracture risk shows a significant correlation with lumbar BMD (p= 0.043), total femoral T-score (p= 0.020) and total femoral BMD (p = 0.029). This data confirms femoral bone density reflects more accurately than vertebral T-score and/or BMD bone strenght, as it is less affected by various interferences (52). On the other hand, BMD is largely recognized as the main determinant of bone strenght of cortical bone (57,58).…”

Section: Clinical Management Of Osteoporotic Vertebral Fracture Treatsupporting

confidence: 64%

“…After all, major osteoporotic fractures include also vertebral fractures and bone density is one of the main determinant of skeletal resistance (52). FRAX score calculated to estimate 10-year probability for femoral fracture risk shows a significant correlation with lumbar BMD (p= 0.043), total femoral T-score (p= 0.020) and total femoral BMD (p = 0.029).…”

Section: Clinical Management Of Osteoporotic Vertebral Fracture Treatmentioning

confidence: 87%

“…However, bone loss magnitude is variable and there is no clearly identified predictor of the individual risk of fracture (53). A recent study interestingly revealed vertebral fracture incidence is higher among oral glucocorticoids users and may be more frequent than usually expected (52). Among other fracture risk factors considered in FRAX tool, smoking, parental fractures, alcohol consumption or other possible causes of secondary OP (55,56), like early menopause, do not seem to produce a major risk for osteoporotic fracture in our sample, if singly considered.…”

Section: Clinical Management Of Osteoporotic Vertebral Fracture Treatmentioning

confidence: 99%

“…In our patients, chronic glucocorticoid therapy seems to deeply influence vertebral Tscore and BMD, as shown by the correlation between use of corticosteroids and lumbar T-score (p=0.013) and BMD (p= 0.022) and total femoral T-score (p=0.034). Many studies prove glucocorticoids cause marked bone loss and relevant alterations of bone quality especially at higher doses and irrespective of methods of administration (51)(52)(53)(54). However, bone loss magnitude is variable and there is no clearly identified predictor of the individual risk of fracture (53).…”

Section: Clinical Management Of Osteoporotic Vertebral Fracture Treatmentioning

confidence: 99%

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Clinical management of osteoporotic vertebral fracture treated with percutaneous vertebroplasty

Capozzi

Scambia

Pedicelli

et al. 2017

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SummaryOur study demonstrated percutaneous vertebroplasty (PVP) is an effective procedure to rapidly reduce back pain in patients affected by acute osteoporotic vertebral compression fractures (OVCFs) assessed by MRI. We confirmed in our sample, femoral bone density impacts more deeply than vertebral T-score and/or BMD on bone strenght, as it is less affected by any interferences. We interestingly found the presence of previous osteoporotic fragility fractures and chronic glucocorticoids therapy should especially negatively influence bone health of our patients. On the other hand, even if both FRAX scores for major osteoporotic fractures and for femoral fractures seemed to globally define a population at major risk for fragility fractures, our analysis is retrospectively done. We choose and suggest a multidisciplinary medical management of these patients, considering OP is a multifactorial disease and OVCFs usually produce lots of different important consequences on general health.

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Section: Resultssupporting

confidence: 68%

Section: Clinical Management Of Osteoporotic Vertebral Fracture Treatsupporting

confidence: 64%

Section: Clinical Management Of Osteoporotic Vertebral Fracture Treatmentioning

confidence: 87%

Section: Clinical Management Of Osteoporotic Vertebral Fracture Treatmentioning

confidence: 99%

Section: Clinical Management Of Osteoporotic Vertebral Fracture Treatmentioning

confidence: 99%

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Clinical management of osteoporotic vertebral fracture treated with percutaneous vertebroplasty

Capozzi

Scambia

Pedicelli

et al. 2017

ccmbm

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Topical Corticosteroids and Glucocorticoid-Induced Osteoporosis—Cumulative Dose and Duration Matter

Jackson

2021

JAMA Dermatol

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Glucocorticoids are used by an estimated 0.5% to 1.0% of adults for management of a range of conditions, from allergies and inflammatory diseases to cancer. 1 Glucocorticoid use increases with age: more than 3% of adults older than 50 years and 5.2% older than 80 years use glucocorticoids. 2 Despite the availability of a growing number of medications to modulate immune function and/or inflammation, evidence from the Danish National Patient Registry suggests that the prevalence of glucocorticoid use has remained remarkably stable for 17 years (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). 3 Thus, any noteworthy adverse effects associated with glucocorticoid use could have substantial consequences not only for the individual, but also for public health.An important adverse effect of glucocorticoid use is its association with the development of osteoporosis. Glucocorticoidinduced osteoporosis (GIOP) is the most common secondary cause of osteoporosis, and as many as 30% of all patients treated with systemic glucocorticoids for more than 6 months will develop GIOP. 4 Fractures are the most serious, adverse clinical outcome associated with high-dose glucocorticoid use and can occur at any skeletal site. [5][6][7] In particular, the risk for vertebral fracture, the most common fracture associated with glucocorticoid use, increases as soon as 3 months and peaks at 12 months after initiating glucocorticoid use. 8 Hip fractures are less common with long-term glucocorticoid use, but are an important adverse outcome owing to related high morbidity and mortality. Estimates of the annual incidence of fractures range from 2.1% in patients who have newly started treatment with glucocorticoids to 5.1% among those with long-term use. 9 The risk for fracture increases with both the dose and duration of glucocorticoid use. For example, at doses of 5 to 7.5 mg of prednisolone, the risk of clinical vertebral fractures increases 2-fold, and of hip fractures, 1.5-fold. 8 However, when high-dose glucocorticoids (30 mg of prednisolone, with a cumulative dose >5 g) are prescribed, the relative risks of vertebral and hip fractures rise 14-fold and 3-fold, respectively. Conversely, when the cumulative dose of intermittent high-dose glucocorticoids is low (<1 g), the fracture risk is much lower than that reported for doses of 1 g or higher. 10 Until recently, most of the GIOP risk attributable to glucocorticoid use was thought to be limited to systemic glucocorticoid use. However, studies of the adverse effects of cumulative doses of glucocorticoids delivered by other modes (eg, inhaled or topical) were limited by small sample sizes, narrow ranges of doses, or short durations of exposures. For example, partly owing to a perceived more favorable balance of risks and benefits, inhaled glucocorticoids are commonly prescribed for a number

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Metabolic Bone Disease in Gastrointestinal Disorders

Bami

Lau

Adachi

2019

Evidence‐based Gastroenterology and Hepatology 4e

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Fracture risk in oral glucocorticoid users: a Bayesian meta-regression leveraging control arms of osteoporosis clinical trials

Cited by 110 publications

References 42 publications

Clinical management of osteoporotic vertebral fracture treated with percutaneous vertebroplasty

Clinical management of osteoporotic vertebral fracture treated with percutaneous vertebroplasty

Topical Corticosteroids and Glucocorticoid-Induced Osteoporosis—Cumulative Dose and Duration Matter

Metabolic Bone Disease in Gastrointestinal Disorders

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