Oral Glucocorticoid use and osteonecrosis in children and adults with chronic inflammatory diseases: a population-based cohort study

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Oral Glucocorticoid use and osteonecrosis in children and adults with chronic inflammatory diseases: a population-based cohort study
Key Take-Away: 

Oral Glucocorticoids are therapeutic agents that exhibit anti-inflammatory properties. As per these study results, there has been an association in Glucocorticoid use and osteonecrosis in a dose-related fashion in adults but not in children.

Introduction:

The research team investigated the oral Glucocorticoids use and risk of osteonecrosis, a rare but severe bone ailment among people with many chronic inflammatory diseases. This analysis also evaluated the relationship in adults versus children and among people with autoimmune diseases.

 

Methods:

A population-representative data from general practices in the UK comprised adults and children with health issues like inflammatory bowel disease; psoriasis; asthma; systemic lupus; or psoriatic or rheumatoid arthritis were selected for the analysis. The subjects were treated with oral Glucocorticoid. Diagnosed osteonecrosis was considered as the primary and osteonecrosis plus clinical features including surgical repair, symptoms, and pain medication were evaluated as secondary outcomes. The adjusted hazard ratio (aHR) of incident osteonecrosis after the oral Glucocorticoid exposure was measured using the discrete-time failure models. Hypothesis testing was one-sided as Glucocorticoids were unlikely protective.

 

Results:

Glucocorticoid exposure was correlated with osteonecrosis among adults after adjusting for disease-related, health utilisation, and demographic factors. But, low-dose Glucocorticoids, corresponding to maximum doses <30 mg daily and average doses <7.5 mg Prednisolone daily, were not linked with osteonecrosis among adults. Moreover, no evidence of raised osteonecrosis among Glucocorticoid-exposed children was seen at high Glucocorticoid doses. Lupus, arthritis, and inflammatory bowel disease were individually linked with osteonecrosis; however, there was a comparable dose association within Glucocorticoids and osteonecrosis in adults with low-risk and high-risk diseases.

 

Conclusions:

Glucocorticoid was unquestionably linked with osteonecrosis in a dose-related manner among adults, particularly young adults, but this risk was not visible in children. In the general paediatric population and adults using low Glucocorticoid doses, the absolute risk of Glucocorticoid-associated osteonecrosis is very minimal.

Source:

BMJ Open. 2017 Jul 21;7(7):e016788

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/28733303

Original title of article:

Oral Glucocorticoid use and osteonecrosis in children and adults with chronic inflammatory diseases: a population-based cohort study.

Authors:

Horton DB et al.

Exploratory, Glucocorticoids, Osteonecrosis, Retrospective cohort study, Oral
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