Abstract
SummaryGlucocorticoid use is a risk factor for osteoporosis and fractures. We studied whether women initiating glucocorticoid treatment also started anti-osteoporotic treatment, according to clinical guidelines. Women with versus without previous fracture were twice as likely to start anti-osteoporotic treatment within 1 year after initiating glucocorticoid treatment, but the cumulative incidences were low 9.1% vs. 4.6%, respectively.PurposeUse of glucocorticoids (GC) is a risk factor for osteoporosis and fractures, and clinical guidelines suggest that preventive treatment with anti-osteoporotic drugs (AOD) should be considered when starting GC. Women with high risk of osteoporosis comprise those with previous fractures or a known inflammatory rheumatic disease, for whom the indication of AOD is even stronger. The purpose of these analyses was to investigate whether women initiating GC treatment also started AOD, especially those with high risk of osteoporosis.MethodsWe used data from the Norwegian Prescription Database to identify all women 55 years and older initiating GC treatment in Norway during 2010–2016 and to obtain information on use of AOD. Data from the Norwegian Patient Registry were used to obtain information on previous fractures and diagnoses.ResultsAmong 105,477 women initiating GC treatment during 2010–2016, 3256 had started AOD and 79,638 had discontinued GC treatment after 1-year follow-up. Cumulative incidence of starting AOD after 1 year was 9.1% (95% CI: 7.9, 10.4) for women with vs. 4.6% (95% CI: 4.4%, 4.8%) for women without a previous fracture. Women with rheumatoid arthritis or another inflammatory rheumatic disease were more likely to start AOD than women with other indications. For the whole cohort, the probability of starting AOD treatment within 1 year after initiating GC increased on average 3% per year (HR = 1.03, CI: 1.01, 1.05) from 2010 to 2016.ConclusionsHaving had a previous fracture or an inflammatory rheumatic disease increased the probability of treatment with AOD. However, the proportions starting AOD were much lower than clinically indicated.
Highlights
Glucocorticoids (GCs) are part of the standard treatment in many conditions including inflammatory, autoimmune, and allergic diseases, cancer, and organ transplantations
About 3.7% of the study population had a fracture before initiation of GC, and the women in this group were older, and they had a higher comorbidity in most disease categories and a higher Charlson comorbidity index (CCI) score than women without fracture
While 3.0% in the total cohort had a diagnosis of rheumatoid arthritis registered in the Norwegian Patient Registry (NPR), 8.6% in the no fracture group and 8.8% in the previous fracture group had a rheumatoid arthritis reimbursement code from the primary or the specialist health care at the first GC dispensing
Summary
Glucocorticoids (GCs) are part of the standard treatment in many conditions including inflammatory, autoimmune, and allergic diseases, cancer, and organ transplantations. Major side effects include osteoporosis and fractures. Use of GC is the most common cause of secondary osteoporosis [2, 3], and 30– 40% of all patients treated with GC have radiological evidence of vertebral fractures [4, 5]. Risk of bone loss and fracture rises rapidly after GC treatment initiation [6,7,8]. For persons with similar bone mineral density (BMD), the risk of vertebral fractures is larger for GC users than for nonusers [9], indicating an additional effect on bone quality. The harmful effects on bone are dose-dependent, but no safe dose limit has been established [8]
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