Use of Oral Corticosteroids and Risk of Hip Fracture in the Elderly in a Case-Control Study.

Cheng-Li Lin,Kuan-Fu Liao,Shih-Wei Lai

doi:10.3389/fphar.2017.00625

Abstract

Aim: Little is known regarding the relationship between use of oral corticosteroids and hip fracture in the elderly in Taiwan. The aim of the study was to examine this issue.Methods: A retrospective population-based case-control study using the database of the Taiwan National Health Insurance Program (2000–2013) was conducted. We identified 4538 individuals aged ≥ 65 years with newly diagnosed hip fracture as the cases. We randomly selected 4538 individuals without hip fracture as the control subjects. The cases and the control subjects were matched with sex, age, comorbidities, and the year of index date. Individuals who never had a prescription for oral corticosteroids were defined as never use. Individuals who ever had at least one prescription for oral corticosteroids were defined as ever use. The odds ratio (OR) and 95% confidence interval (CI) of hip fracture associated with oral corticosteroids use was estimated by a multivariable unconditional logistic regression analysis.Results: After adjustments for potential confounding factors, the multivariable logistic regression model showed that the adjusted OR of hip fracture was 1.17 for individuals with ever use of oral corticosteroids (95%CI 1.08, 1.28), compared to those with never use of oral corticosteroids. An sub-analysis showed that for every 1-mg increase in cumulative dose of oral corticosteroids, the adjusted OR of hip fracture was 1.01 (95% CI 1.01, 1.02). The adjusted ORs were 1.31 (95% CI 1.17, 1.47) for cumulative exposure to oral corticosteroids ≥ 3 months and 1.09 (95% CI 0.98, 1.20) for cumulative exposure < 3 months.Conclusion: We conclude that oral corticosteroids use is associated with a trivial but statistically significant increase in risk of hip fracture in Taiwan. Additionally, the results suggest that there are dose-response and duration-response effects of oral corticosteroids on the risk of hip fracture. The results confirm our understanding of oral corticosteroid-associated hip fracture in the elderly.

Highlights

Hip fracture persists to be an important public health problem in the elderly worldwide due to its large socioeconomic burden, substantial morbidity and mortality
A systematic Review by Mohd-Tahir and Li (2017) reported that healthcare costs associated with hip fracture accounted for more than one third of gross domestic product (GDP) in some counties of Asia
The cases were more likely to have a higher proportion of ever use of oral corticosteroids than the control subjects (42.1% vs. 38.5%, Chi-square test, P < 0.001)

Summary

Introduction

Hip fracture persists to be an important public health problem in the elderly worldwide due to its large socioeconomic burden, substantial morbidity and mortality. A prospective cohort study in Taiwan by Hung et al (2014) reported that the hip-fractured older people were at higher risk of mortality compared with the non-fractured matched older people. It is well-known that individuals with corticosteroids use are at an excess risk of osteoporotic fractures. A population-based case-control study in Denmark by Vestergaard et al (2003) reported that corticosteroid users were at increased risk of hip fracture compared to never users. A meta-analysis by Kanis et al (2004) reported that corticosteroids use correlated with high risk of hip fracture in the elderly aged 65–85 (relative risk 2.13–2.98)

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