PMS5 - Association Between Steroid Exposure and Osteoporotic Fracture In Korean Women: A Nested Case-Control Study Using A National Sample Cohort

Abstract

Frequently prescribed steroid may induce osteoporosis and osteonecrosis, and increase the risk of osteoporotic fractures (OF). This study was conducted to assess the association between steroid exposure and OF in Korean women after middle age. This nested case-control study selected 21,625 pairs of women aged 50 or older with OF for cases and matched controls based on the national sample cohort database 2002-2013. OF was defined as newly diagnosed fractures having osteoporosis 1 year before or after the first fracture diagnosis. The steroid prescription rate (SPR) over the past 1 year from the index date (the diagnosis date of OF) was analyzed. The odds for OF by SPR were analyzed with or without adjusting polypharmacy exposure (defined as 5 or more daily prescription drugs in average) and Charlson Comorbidity Index (CCI) score. In addition, case-crossover study using case only (n=21,625) was conducted. The mean age of target cohort was 69.3 years (standard deviation [SD]: 8.2). CCI score and polypharmacy prevalence were higher in cases compared to controls (2.1 [SD: 1.9] vs. 1.7 [SD: 1.8], 25.4% vs. 20.9% respectively). The ORs for OF adjusted with polypharmacy and CCI score increased with steroid exposure level, and the ORs (95% confidence interval) with reference of no steroid prescription were 1.33 (1.28-1.39) for >0-25% SPR, 1.90 (1.59-2.89) for >25-50% SPR, 2.31 (1.75-3.05) for >50-75% SPR, and 2.74 (2.18-3.44) for >75-100% SPR. Case-crossover study confirmed the risk of OF by steroid use. The ORs were 1.083-1,156 in various hazard periods with statistical significance. The results of this study suggest that steroid exposure in women after middle age is associated with OF in which levels of steroid exposure were related with an increasing the risk.