Effects of Systemic Glucocorticoid Use on Fracture Risk: A Population-Based Study

Abstract

Background: Long-term glucocorticoid use increases fracture risk by reducing bone mass. This study evaluated the relationship between hip and vertebral fractures and the total amount of systematic glucocorticoid use. Methods: We randomly selected 1,896,159 people aged 20 to 100 years who participated in the National Health Checkup programin 2006. The amount of glucocorticoids prescribed was calculated based on the defined daily dose (DDD). The total DDD was obtained by adding oral and parenteral glucocorticoids for 6 months from the index date. Subjects were categorized into four groupsaccording to total glucocorticoid DDDs: non-users (DDDs=0), low users (0< DDDs ≤45), intermediate users (45< DDDs ≤90),and high users (90< DDDs). We followed them for 2 years. A multivariate Cox proportional hazard model was used to evaluate theeffects of the total amount of glucocorticoid use on hip and vertebral fractures. Results: Higher glucocorticoid use was associated with a higher risk of vertebral fracture. Relative to non-users, the vertebral fracturerisk was 1.39 times higher in the low-user group, 1.94 times higher in the intermediate-user group, and 2.43 times higher in the highuser group. The risk of hip fracture was 1.72 times higher in intermediate users and 3.28 times higher in high users than in non-users. Conclusion: As the amount of glucocorticoid use for 6 months increased, the risk of hip and vertebral fractures became higher. Inorder to prevent fractures, it is necessary for doctors to evaluate the total amount of glucocorticoid prescribed to the patient and toprovide appropriate treatment.