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Fracture Risk Associated with Different Types of Oral Corticosteroids and Effect of Termination of Corticosteroids on the Risk of Fractures

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Abstract

We conducted a case–control study on fracture risk associated with the use of orally administered prednisolone/prednisone, budesonide, methylprednisolone, and hydrocortisone to assess if the various preparations were associated with different fracture patterns. Cases were all subjects with any fracture sustained during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched on age and gender were randomly drawn from the background population. Adjustments were made for concurrent diseases, use of other drugs, and a number of other factors. Oral prednisolone/prednisone was associated with a dose-dependent increase in fracture risk starting from a dose of around 6.7 mg/day. Oral budesonide was not associated with an increase in overall fracture risk, but the doses in general were low (<3 mg/day). Oral hydrocortisone was not associated with overall risk of fractures. Oral methylprednisolone was only used intermittently and was not associated with an increase in overall fracture risk at the low doses used. After termination of oral prednisolone/prednisone, it took more than 1 year for fracture risk to return to the levels of the background population. Oral prednisolone is associated with a dose-dependent increase in overall fracture risk. Budesonide at low doses did not seem to be associated with fracture risk. Hydrocortisone was not associated with an increase in the risk of fractures. It may take a year from last use of prednisolone/prednisone before fracture risk returns to that of the general population.

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Acknowledgements

The National Bureau of Statistics (Statistics Denmark) is acknowledged for its help, without which this project would not have been possible. Research librarian Ms. Edith Clausen is acknowledged for help with the references. The Danish Medical Research Council provided financial support (grant number 22-04-0495).

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Authors and Affiliations

  1. The Osteoporosis Clinic, Aarhus Sygehus, Tage Hansens Gade 2, 8000, Aarhus C, Denmark

    Peter Vestergaard

  2. Department of Endocrinology and Metabolism C, Aarhus Sygehus THG, Aarhus University Hospital, Aarhus, Denmark

    Peter Vestergaard, Lars Rejnmark & Leif Mosekilde

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  1. Peter Vestergaard
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  2. Lars Rejnmark
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  3. Leif Mosekilde
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Correspondence to Peter Vestergaard.

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Vestergaard, P., Rejnmark, L. & Mosekilde, L. Fracture Risk Associated with Different Types of Oral Corticosteroids and Effect of Termination of Corticosteroids on the Risk of Fractures. Calcif Tissue Int 82, 249–257 (2008). https://doi.org/10.1007/s00223-008-9124-7

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  • DOI: https://doi.org/10.1007/s00223-008-9124-7

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