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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.
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.
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.
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.
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.
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.
BMJ Open. 2017 Jul 21;7(7):e016788
Oral Glucocorticoid use and osteonecrosis in children and adults with chronic inflammatory diseases: a population-based cohort study.
Horton DB et al.
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