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Corticosteroid Users (corticosteroid + user)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

Use of Oral Corticosteroids and Risk of Fractures

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2000
T. P. Van Staa
Abstract Treatment with oral corticosteroids is known to decrease bone density but there are few data on the attendant risk of fracture and on the reversibility of this risk after cessation of therapy. A retrospective cohort study was conducted in a general medical practice setting in the United Kingdom (using data from the General Practice Research Database [GPRD]). For each oral corticosteroid user aged 18 years or older, a control patient was selected randomly, who was matched by age, sex, and medical practice. The study comprised 244,235 oral corticosteroid users and 244,235 controls. The average age was 57.1 years in the oral corticosteroid cohort and 56.9 years in the control cohort. In both cohorts 58.6% were female. The most frequent indication for treatment was respiratory disease (40%). The relative rate of nonvertebral fracture during oral corticosteroid treatment was 1.33 (95% confidence interval [CI], 1.29,1.38), that of hip fracture 1.61 (1.47,1.76), that of forearm fracture 1.09 (1.01,1.17), and that of vertebral fracture 2.60 (2.31,2.92). A dose dependence of fracture risk was observed. With a standardized daily dose of less than 2.5 mg prednisolone, hip fracture risk was 0.99 (0.82,1.20) relative to control, rising to 1.77 (1.55,2.02) at daily doses of 2.5,7.5 mg, and 2.27 (1.94,2.66) at doses of 7.5 mg or greater. For vertebral fracture, the relative rates were 1.55 (1.20,2.01), 2.59 (2.16,3.10), and 5.18 (4.25,6.31), respectively. All fracture risks declined toward baseline rapidly after cessation of oral corticosteroid treatment. These results quantify the increased fracture risk during oral corticosteroid therapy, with greater effects on the hip and spine than forearm. They also suggest a rapid offset of this increased fracture risk on cessation of therapy, which has implications for the use of preventative agents against bone loss in patients at highest risk. [source]

Use of Inhaled Corticosteroids and Risk of Fractures

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2001
T. P. Van Staa
Abstract Treatment with systemic corticosteroids is known to increase the risk of fractures but little is known of the fracture risks associated with inhaled corticosteroids. A retrospective cohort study was conducted using a large UK primary care database (the General Practice Research Database [GPRD]). Inhaled corticosteroid users aged 18 years or older were compared with matched control patients and to a group of noncorticosteroid bronchodilator users. Patients with concomitant use of systemic corticosteroids were excluded. The study comprised 170,818 inhaled corticosteroid users, 108,786 bronchodilator users, and 170,818 control patients. The average age was 45.1 years in the inhaled corticosteroid, 49.3 years in the bronchodilator, and 45.2 years in the control groups. In the inhaled corticosteroid cohort, 54.5% were female. The relative rates (RRs) of nonvertebral, hip, and vertebral fractures during inhaled corticosteroid treatment compared with control were 1.15 (95% CI, 1.10,1.20), 1.22 (95% CI, 1.04,1.43), and 1.51 (95% CI, 1.22,1.85), respectively. No differences were found between the inhaled corticosteroid and bronchodilator groups (nonvertebral fracture RR = 1.00; 95% CI, 0.94,1.06). The rates of nonvertebral fractures among users of budesonide (RR = 0.95; 95% CI, 0.85,1.07) and fluticasone propionate (RR = 1.03; 95% CI, 0.71,1.49) were similar to the rate determined for users of beclomethasone dipropionate. We conclude that users of inhaled corticosteroids have an increased risk of fracture, particularly at the hip and spine. However, this excess risk may be related more to the underlying respiratory disease than to inhaled corticosteroid. [source]

Use of Oral Corticosteroids and Risk of Fractures

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2000
T. P. Van Staa
Abstract Treatment with oral corticosteroids is known to decrease bone density but there are few data on the attendant risk of fracture and on the reversibility of this risk after cessation of therapy. A retrospective cohort study was conducted in a general medical practice setting in the United Kingdom (using data from the General Practice Research Database [GPRD]). For each oral corticosteroid user aged 18 years or older, a control patient was selected randomly, who was matched by age, sex, and medical practice. The study comprised 244,235 oral corticosteroid users and 244,235 controls. The average age was 57.1 years in the oral corticosteroid cohort and 56.9 years in the control cohort. In both cohorts 58.6% were female. The most frequent indication for treatment was respiratory disease (40%). The relative rate of nonvertebral fracture during oral corticosteroid treatment was 1.33 (95% confidence interval [CI], 1.29,1.38), that of hip fracture 1.61 (1.47,1.76), that of forearm fracture 1.09 (1.01,1.17), and that of vertebral fracture 2.60 (2.31,2.92). A dose dependence of fracture risk was observed. With a standardized daily dose of less than 2.5 mg prednisolone, hip fracture risk was 0.99 (0.82,1.20) relative to control, rising to 1.77 (1.55,2.02) at daily doses of 2.5,7.5 mg, and 2.27 (1.94,2.66) at doses of 7.5 mg or greater. For vertebral fracture, the relative rates were 1.55 (1.20,2.01), 2.59 (2.16,3.10), and 5.18 (4.25,6.31), respectively. All fracture risks declined toward baseline rapidly after cessation of oral corticosteroid treatment. These results quantify the increased fracture risk during oral corticosteroid therapy, with greater effects on the hip and spine than forearm. They also suggest a rapid offset of this increased fracture risk on cessation of therapy, which has implications for the use of preventative agents against bone loss in patients at highest risk. [source]

Attempted randomized controlled trial of pamidronate versus calcium and calcitriol supplements for management of steroid-induced osteoporosis in children and adolescents

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2005
JJ Brown
Objectives: To describe an attempted interventional trial for glucocorticoid-induced osteoporosis in children and adolescents and to discuss the reasons for trial failure to inform future interventional studies in this important group of patients. Methods: Prospective randomized controlled trial comparing the effect of bisphosphonate therapy with calcium and vitamin D supplementation on bone mineral accrual is described. For non-trial patients, retrospective analysis of the effect of calcium and vitamin D supplementation combined with bisphosphonate treatment on bone mineral accrual. Results: Only 12 patients were enrolled in the trial over 4 years. Bisphosphonate recipients (n = 5) had a mean annual percentage increase in lumbar spine bone mineral density of 8.76 ± 5.2% compared to 6.6 ± 4.0% in the calcium/vitamin-treated group (difference not significant). Mean annual change in lumbar spine areal bone mineral density in non-trial patients (n = 11) was 3.72 ± 2.5%. Conclusion: Conducting a randomized controlled trial in this group of corticosteroid users is difficult, given the unpredictable nature of the underlying disease and intermittent need for steroid treatment. The trial failed through inadequate recruitment combined with discontinued interventions. [source]