GENEVA, Switzerland-Short-term use of high-dose steroids does not appear to increase fracture risk, according to new research1 presented Monday at the Second Joint Meeting of the European Calcified Tissue Society (ECTS) and the International Bone and Mineral Society (IBMS) in Geneva, Switzerland.
"We already knew that nonvertebral fracture risk substantially increases after continuous use of oral glucocorticosteroids, especially when taking more than five milligrams of prednisolone (equivalent) per day," lead researcher Frank de Vries, MSc, a PhD candidate at the Utrecht Institute for Pharmaceutical Sciences in Utrecht, The Netherlands, tells CIAOMed. But now we know that "a short-term, high dose of >e;15 mg/day oral glucocorticosteroid prescription does not increase fracture risk when the previous oral glucocorticosteroid prescription has ended more than 1 year before."
The new study included 92,000 patients from the United Kingdom General Practice Research database over age 40 who took oral steroids for respiratory disease. In the study, patients on short-term, high-dose therapy received more prednisolone (equivalent) per day. A short course was characterized by a cumulative dose of less than one gram. According to de Vries, this would be the equivalent, for example, of taking a 30 mg daily dose of prednisolone during a maximum period of 33.3 days.
According to the findings, patients who took steroids for 6 to 14 days equaling more than 15 mg/day did not have an increased risk of osteoporosis or fracture. Moreover, those patients who took more than 30 mg/day only had a small increase in overall fracture risk and no increased risk for devastating hip fracture, the study showed.
By contrast, long-term steroid users who were taking more than 5 grams of prednisolone continuously had a 3-fold increased risk of fracture.
Continuous use was evaluated only among patients taking 15 mg or more prednisolone equivalent per day, de Vries explains. Patients who were still taking steroids had a 90% increased risk of hip fracture and were more than 6 times as likely to sustain a vertebral fracture, compared with those who had stopped taking glucocorticosteroids for 3 months or longer, the study showed.
Benefits and risks must be weighed before recommending to RA patients
Commenting on a recently reported study by CIAOMed showing that the anti-inflammatory effects of prednisolone slow the loss of hand bone density in patients with early rheumatoid arthritis (RA),2 de Vries says that "these findings are intriguing, and may be good news for patients who suffer from RA. However, we know from previous work that nonvertebral fracture risk substantially increases after continuous use of more than 5 mg prednisolone (equivalent) per day. Therefore, this favorable property of prednisolone should be weighed against its side effects before we can recommend this as a new medicine for patients who suffer from RA."
References:
- de Vries, F, et al. Risk of fracture in patients using high-dose intermittent oral glucocorticoids. Presented at: 2nd Joint Meeting of the ECTS and the IBMS; June 25-29, 2005; Geneva, Switzerland. Abstract OC024.
- Haugeberg G, Strand A, Kvien TK, Kirwan JR. Reduced loss of hand bone density with prednisolone in early rheumatoid arthritis: results from a randomized placebo-controlled trial. Arch Intern Med. 2005;165:1293-1297.