Fracture risk assessment three months after initiation of glucocorticoid therapy useful, recommends study

A recent study revealed the necessity of fracture risk assessment three months after the initiation of glucocorticoid (GC) therapy. The research by determined whether exposure to GCs within the first 90 days is linked to an increased risk of subsequent hip and clinical vertebral fractures.

The study utilized nationwide health insurance claims database (NDBJ) from Japan and analyzed data from patients who were over 50 years and were prescribed GCs, specifically the patients who were receiving at least 70 mg of prednisolone (PSL) or its equivalent within the initial 90 days of therapy. This study followed these patients for an additional 1080 days to monitor incidences of hip and clinical vertebral fractures. The study population included a total of 316,396 women and 299,871 men in the GC-exposed group when compared with the 43,164 women and 33,702 men in the reference group.

The key findings of this study were;

The analysis revealed a significant, dose-dependent increase in fracture risk associated with higher GC doses and longer durations within the initial 90 days of therapy. 

The patients who were prescribed GCs for 30 to 59 days at doses of 5 mg PSL/day or higher had a notably increased fracture risk when compared to the reference group.

The female patients on GCs at daily doses between 1 mg and 2.5 mg PSL for the entire 90 days showed a significantly elevated fracture risk.

These results indicate that even lower doses and shorter durations of GC therapy than previously understood can significantly elevated fracture risk.

The study concludes that GC exposure during the first 90 days of therapy is a crucial period where fracture risk is dose-dependent. This illuminates the importance of early fracture risk assessment by recommending that such evaluations should be conducted three months after the initiation of GC therapy. The findings suggest that clinicians need to be careful in monitoring and managing fracture risk from the outset of GC treatment, even at lower doses.

This research provides strong evidence to reassess current practices regarding GC therapy. With the established link between early GC exposure and increased fracture risk, the proactive measures, including bone health assessments and preventive strategies should be prioritized to reduce the long-term impact on patients.

Source: 

Iki, M., Fujimori, K., Nakatoh, S., Tamaki, J., Ishii, S., Okimoto, N., Imano, H., & Ogawa, S. (2024). Average daily glucocorticoid dose, number of prescription days, and cumulative dose in the initial 90 days of glucocorticoid therapy are associated with subsequent hip and clinical vertebral fracture risk: a retrospective cohort study using a nationwide health insurance claims database in Japan. In Osteoporosis International (Vol. 35, Issue 5, pp. 805–818). Springer Science and Business Media LLC. https://doi.org/10.1007/s00198-024-07023-6