Oral corticosteroids and fracture risk: relationship to daily and cumulative doses

Objective. This study examined the effects of daily and cumulative oral cor ticosteroid doses on the risk of fractures. Methods. Information was obtained from the General Practice Research Databa se, which contains medical records of general practitioners in England and Wales. The study included 244 235 oral corticosteroid users and 244 235 con trols. Results. Patients taking higher doses (at least 7.5 mg daily of prednisolon e or equivalent) had significantly increased risks of non-vertebral fractur e [relative rate (RR) = 1.44, 95% confidence interval (CI) 1.34-1.54], hip fracture (RR = 2.21, 95% CI 1.85-2.64) and vertebral fracture (RR = 2.83, 9 5% CI 2.35-2.40) relative to patients using oral corticosteroids at lower d oses (less than 2.5 mg per day). Fracture risk was also elevated among peop le with higher cumulative exposure to oral corticosteroids over the study p eriod, but this effect was almost wholly removed by adjustment for daily do se, age, gender and other confounding variables. Conclusions. These findings suggest that the adverse skeletal effects of or al corticosteroids manifest rapidly and are related to daily dose. The leve l of previous exposure to oral corticosteroids was not a strong determinant of the risk of fracture. Preventive measures against corticosteroid-induce d osteoporosis should therefore be instituted as soon after the commencemen t of glucocorticoid therapy as possible.