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Original Investigation
October 23, 2000

Vertebral Fracture Risk With Long-term Corticosteroid Therapy: Prevalence and Relation to Age, Bone Density, and Corticosteroid Use

Author Affiliations

From the Department of Rheumatology, Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, New South Wales (Dr Naganathan), Menzies Centre for Population Health Research, Hobart, Tasmania (Dr Jones), Sunshine Coast, Queensland (Dr Nash), Department of Medicine, Geelong Hospital, Geelong, Victoria (Dr Nicholson), Department of Medicine, Bone and Mineral Research Division, Garvan Institute of Medicine, St Vincent's Hospital, Sydney, New South Wales (Dr Eisman), and Department of Rheumatology, Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, New South Wales (Dr Sambrook), Australia.

Arch Intern Med. 2000;160(19):2917-2922. doi:10.1001/archinte.160.19.2917

Background  Few data are available regarding vertebral fracture risk in patients treated with oral corticosteroids. The aim of this study was to determine the prevalence and the role of risk factors such as age, bone mineral density (BMD), and corticosteroid use for vertebral deformity in patients receiving long-term corticosteroid therapy.

Methods  Thoracolumbar x-ray films, BMD, and details on corticosteroid use were obtained on 229 consecutive patients treated with long-term corticosteroid regimens (≥6 months of prednisone, ≥5mg/d or equivalent) seen at 4 referral centers. Comparisons were made with a population control group of 286 male and female controls not taking corticosteroids (aged ≥60 years).

Results  Sixty-five patients (28%) had at least 1 vertebral deformity and 25 (11%) had 2 or more vertebral deformities. Older age, independent of BMD, was a significant risk factor for deformity. Patients aged 70 to 79 years had a 5-fold increased risk of deformity compared with patients younger than 60 years (odds ratio, 5.13; 95% confidence interval, 2.03-13.0). Compared with the population controls, the prevalence of deformities increased to a greater extent with each decade of age in the corticosteroid group (P = .005). Mean lumbar spine and femoral neck BMD Z scores were lower in the steroid-treated patients with deformities compared with the nonsteroid control group with deformities. When the effects of age, sex, body mass index, and duration of corticosteroid use were adjusted for in logistic regression analysis, low BMD was a modest predictor of deformity (for a 1-SD decrease in lumbar spine BMD: odds ratio, 1.31; 95% confidence interval, 1.02-1.68) and for a 1-SD decrease in femoral neck BMD: odds ratio, 1.77; 95% confidence interval, 1.07-2.94).

Conclusions  The combination of increasing age and corticosteroid use is associated with a marked increase in the risk of vertebral deformity. Elderly patients commencing long-term corticosteroid therapy should be considered for antiosteoporotic therapy independently of their BMD.