Paradoxically protective effect of glucocorticoids on bone mass and fragility fracture in a large cohort: a cross-sectional study

• Published in: Rheumatology advances in practice Vol. 6; no. 2; p. rkab089
• Main Authors: Bukhari, Marwan, Goodson, Nicola, Boers, Maarten
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.07.2022
• Subjects: Analysis; Bones; Concise Report; Corticosteroids; Density; Epidemiology; Fractures; Risk factors; United Kingdom; bone mineral density; epidemiology; risk factors; fragility fractures; glucocorticoids; dual X-ray absorptiometry; modelling
• ISSN: 2514-1775; 2514-1775
• DOI: 10.1093/rap/rkab089

Abstract Objectives Glucocorticoids (GCs) increase the risk of fracture through reduction in BMD; they may also reduce bone quality, but recent supporting data are scarce. We aimed to confirm these effects in a large population-based cohort. Methods We used data from patients referred for first hip and lumbar spine BMD estimation by the sole DXA scanner in the north-west of England between June 2004 and September 2016. We compared the history of fractures and BMD between patients currently on GCs and patients never exposed to GC. A logistic model adjusted for possible confounders. Results More than 20 000 subjects were included, 82% female, with mean age 63 (s.d. 13) years; 19% were currently on GCs. The patients on GCs were more often male, with higher BMI, but their age was similar to those not exposed to GC. Surprisingly, patients receiving GCs had ∼2% higher BMD at both sites (P < 0.001) and lower prevalence of (history of) fractures (22% vs 34%; P < 0.001). The corresponding odds ratio was 0.53 (95% CI: 0.49, 0.58); adjustment for age, sex, BMI and the number of indications for scanning did not alter the association. Conclusion In this large population-based cohort, current GC use compared with never use was associated with higher bone mass and fewer rather than more fractures after adjusting for confounders. These results might be subject to unmeasured confounding, but for now they do not lend support to a detrimental effect of GCs on bone.