Use of Glucocorticoids May Increase Risk of Bone Fracture, Study Finds

Patients with sarcoidosis who are exposed to glucocorticoids have an increased risk of developing osteoporosis and experiencing bone fractures, according to the results of a new study. However, people without sarcoidosis who receive glucocorticoid treatment have a similar risk, suggesting it is not the disease itself that increases this risk, but rather the glucocorticoid treatment.

The study reporting the findings, “Use of systemic glucocorticoids and the risk of major osteoporotic fractures in patients with sarcoidosis,” was published in the journal Osteoporosis International.

“Treatment with [glucocorticoids] has been associated with a decrease in [bone mass density] and an increased fracture risk, particularly fractures of the hip and vertebrae,” researchers wrote. “The onset of [glucocorticoid]-induced fracture risk occurs rapidly, increases with higher average daily doses, and drops quickly to baseline after discontinuation.”

To assess the risk of having osteoporotic fractures in patients with and without sarcoidosis, and the potential relationship between fractures and the use of glucocorticoids, researchers analyzed medical records in the Danish National Hospital Discharge Registry (NHDR) between January 1995 and December 2011.

The team identified 376,858 individuals with major osteoporotic fractures and a similar number of people without (mean age of 64.2).

Among these individuals, 124 had sarcoidosis and the use of glucocorticoids was found to be associated with a 1.74 risk of having a osteoporotic fracture. Discontinuation of the treatment with glucocorticoids led to a decrease in the risk of fractures to levels seen before the treatment.

Interestingly, among non-sarcoidosis individuals, glucocorticoid treatment was associated with a similar risk of osteoporotic fractures (1.36).

“Current [glucocorticoid] use was associated with increased risk of hip fracture in both sarcoidosis subjects and patients without sarcoidosis,” researchers wrote. “Similarly, the risk of clinically symptomatic vertebral fracture was increased with current [glucocorticoid] use in patients with sarcoidosis and without sarcoidosis.”

Specifically, a cumulative dose of prednisolone ranging between 1 to 4.9 g and above 10 g were associated with increased risk of major osteoporotic fracture. A cumulative dose lower than 1 g and ranging from 5 to 9.9 g did not increase the risk of bone fracture.

“Both in subjects with and without sarcoidosis, current expose to [glucocorticoids] is associated with increased risk of major osteoporotic fractures, with no between-group difference,” the researchers concluded. “Sarcoidosis per se was not associated with increased fracture risk. Having sarcoidosis per se, i.e., if not treated with [glucocorticoids], is not a risk factor for fracture, and such patients may only need risk assessment when they commence [glucocorticoid] therapy.”