Impact of cumulative exposure to high-dose oral glucocorticoids on fracture risk in Denmark: a population-based case-control study
Impact of cumulative exposure to high-dose oral glucocorticoids on fracture risk in Denmark: a population-based case-control study
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DOI：
10.1007/s11657-018-0424-x
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发表时间：
2018-03-18
影响因子：
3
通讯作者：
Burden, Andrea M.
中科院分区：
文献类型：
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作者：
Amiche, M. Amine;Abtahi, Shahab;Burden, Andrea M.
我们研究了累积暴露于高剂量口服糖皮质激素对骨折风险的影响。与短期使用者（日剂量>= 15 mg +累积剂量< 1 g）相比，重度使用者（日剂量>= 15 mg +累积剂量>= 1 g）骨折风险最高。这些患者应监测骨折managementstrategy.Purpose累积暴露于高剂量的口服糖皮质激素对骨折风险的影响仍有争议。因此，我们的目的是检查短期和大量使用高剂量口服糖皮质激素的髋部骨折的风险。方法我们进行了一项基于人口的病例对照研究，使用丹麦国家卫生服务数据，1996-2011年。病例为年龄≥ 18岁的髋关节（主要结局）骨折患者（n = 81，342）。在次要分析中考虑了椎骨和前臂骨折。对照组（1：1匹配）为无骨折的患者。计算当前口服糖皮质激素使用者的平均日剂量（DD）和总累积剂量（CD）。在高日剂量（DD = 15 mg）的患者中，我们确定CD < 1 g的患者为短期使用者，CD = 1 g的患者为重度使用者。我们估计了调整后的比值比结果高DD（>= 15 mg）和高CD（>= 1 g）分别与髋部骨折风险增加独立相关（adj. OR 2.5; 95%CI 2.2-2.9; adj. OR 1.6; 95%CI 1.5-1.8）。然而，与短期使用者（DD ≥ 15 mg和CD <1 g：adj. OR 1.4; 95% CI 1.1-1.9）相比，重度使用者（DD ≥ 15 mg和CD ≥ 1 g：adj. OR 2.9; 95% CI 2.5-3.4）的风险显著增加。相关性较强的椎骨骨折，但很少有关联被确定为前臂fractures.Conclusion患者接受高DD（>= 15 mg），重度使用者（>= 1 g CD）表现出最大的髋部骨折的风险增加。在接收高DD的那些用户中，Ig CD的阈值可以识别作为针对集中的断裂管理服务的候选者的重度用户。
A Summary We examined the effect of cumulative exposure to high doses of oral glucocorticoids on fracture risk. Compared to short-course users (daily dose >= 15 mg + cumulative < 1 g), heavy users (daily dose >= 15 mg + cumulative dose >= 1 g) had the highest risk of fracture. These patients should be monitored for fracture management strategies.Purpose The effect of cumulative exposure to high daily doses of oral glucocorticoids on fracture risk remains debated. We therefore aimed to examine the hip fracture risk associated with short courses and heavy use of high-dosed oral glucocorticoids.Methods We conducted a population-based case-control study using the Danish National Health Service data, 1996-2011. Cases were those aged >= 18 years who sustained a hip (primary outcome) fracture (n = 81,342). Vertebral and forearm fractures were considered in secondary analyses. Controls (matched 1:1) were those without a fracture. Average daily dose (DD) and total cumulative dose (CD) were calculated among current oral glucocorticoid users. Among patients with a high daily dose (DD = 15 mg), we identified short-course users as those with a CD < 1 g and heavy users as those with a CD = 1 g. We estimated adjusted odds ratio (adj. OR) of fracture with current glucocorticoid use compared to never-use, using conditional logistic regression.Results A high DD (>= 15 mg) and high CD (>= 1 g) were independently associated with an increased hip fracture risk (adj. OR 2.5; 95% CI 2.2-2.9; adj. OR 1.6; 95% CI 1.5-1.8, respectively). However, the risk was substantially increased among heavy users (DD >= 15 mg and CD >= 1 g: adj. OR2.9; 95% CI 2.5-3.4) as compared to short-course users (DD >= 15 mg and CD < 1 g: adj. OR 1.4; 95% CI 1.1-1.9). Associations were stronger for vertebral fractures, yet little association was identified for forearm fractures.Conclusion Among patients receiving a high DD (>= 15 mg), heavy users (>= 1 g CD) showed the most substantial increase in hip fracture risk. Among those receiving high DD, a threshold of 1 g CD may identify heavy users that are candidates for focused fracture management services.