Topical steroids may increase risk of osteoporosis, fractures: JAMA Study

Clinical guidelines recommend long-term use of potent Topical Corticosteroids (TCSs) in patients with psoriasis, atopic dermatitis, and other inflammatory diseases and even in those with extensive disease affecting large body areas. However, whether such prolonged use of TCSs may increase the risk of osteoporosis and major osteoporotic fracture (MOF) is unknown. Given the widespread use of TCSs, even a small increase in the risk of osteoporosis or MOF would be important from a public health perspective. The effect of high cumulative use of potent or very potent TCSs on the risk for osteoporosis and MOF needs to be quantified to better support treatment decisions in patients requiring long-term treatment. For this purpose, researchers conducted a study to examine the association between the use of potent or very potent TCSs and the risk of osteoporosis and MOF in adults.

It was a Danish population-based, retrospective cohort study that included 723 251 Danish adults treated with the equivalent of at least 200 g of mometasone from January 1, 2003, to December 31, 2017. Researchers used Danish nationwide registries to obtain data. Filled prescription data were converted in equipotent doses to mometasone furoate (1 mg/g). The major outcomes assessed were a diagnosis of osteoporosis or MOF.

Key findings of the study were:

♦ Researchers found a dose-response association between the increased use of potent or very potent TCSs and the risk of osteoporosis and MOF. (Eg., HRs of MOF were:  

                    • 1.01 for exposure to 500 to 999 g,

                    • 1.05 for exposure to 1000 to 1999 g,

                    • 1.10 for exposure to 2000 to 9999 g,

                    • 1.27 for exposure to at least 10 000 g).

♦ They found an overall population-attributable risk for TCSs of as much as 4.3% for osteoporosis and 2.7% for MOF.

♦ Upon doubling the cumulative TCS dose, they observed a 3% increase in the relative risk of osteoporosis and MOF (HR, 1.03 ).

The authors concluded, "These findings demonstrate that use of high cumulative amounts of potent or very potent TCSs was associated with an increased risk of osteoporosis and MOF".

For further information:

https://jamanetwork.com/journals/jamadermatology/fullarticle/2775153