Cumulative Dose of Topical Corticosteroids is Associated with Osteoporosis and Major Osteoporotic Fracture: A Nationwide Case-Control Study
Journal
SSRN
Date Issued
2023-07
Author(s)
Abstract
Background: The cumulative dose of potent/very potent topical corticosteroids (TCSs) is associated with osteoporosis and major osteoporotic fracture (MOF). However, connections between long-term use of low- to mid-potency TCSs and osteoporosis and MOF are unknown. This study aims to examine the association between cumulative TCS dose of varying potency and risk of osteoporosis and MOF.
Methods: We conducted a nationwide case-control study and obtained data from Taiwan National Health Insurance Research Database. From 2017 to 2020, 129,682 osteoporosis cases and 34,999 MOF cases were selected and randomly matched with 518,728 and 139,996 controls by sex and age. Cumulative TCS doses in different exposure periods were calculated and the potency of TCSs was converted to prednisolone equivalent. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for osteoporosis and MOF associated with TCS use.
Findings: We found clear dose–response relationships between long-term TCS exposure and osteoporosis and MOF. Compared to no TCS use, adjusted ORs of osteoporosis were 1.216 (95% CI 1.189–1.243), 1.260 (95% CI, 1.241–1.280), and 1.341 (95% CI, 1.314–1.369) for exposure to low, medium, and high cumulative TCS doses, respectively, over five years. Adjusted ORs of MOF were 1.118 (95% CI 1.069–1.170), 1.191 (95% CI, 1.156–1.227), and 1.288 (95% CI, 1.238–1.340) for exposure to low, medium, and high cumulative TCS doses, respectively, over five years. Stratified analysis showed women had higher ORs of osteoporosis and MOF compared to men. Younger people (<50 years) had highest OR of osteoporosis compared to other age groups.
Interpretation: Higher cumulative TCS dose, even with low- or mid- potency, was associated with increased risk of osteoporosis and MOF. Long-term use of TCSs should be cautious and use of other dermatology medication without harmful effects on bone may be considered, especially in susceptible populations.
Funding: None declared.
Declaration of Interest: None declared.
Ethical Approval: This study was approved by the National Taiwan University Hospital Research Ethics Committee (201802007RINA). © 2023, The Authors. All rights reserved.
Subjects
case-control study
fracture
osteoporosis
Topical corticosteroids
SDGs
Type
other