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The use
of oral glucocorticoids should be carefully considered in adults below 50 years
or those consuming high doses as the risk of osteonecrosis were found to
increase with increasing dose of glucocorticoids.
Glucocorticoids are classified under steroids & well known for its anti-inflammatory and immunosuppressive properties. The glucocorticoids frequently used for various inflammatory disease management. Many of these glucocorticoids related to some toxicities such as osteonecrosis. Osteonecrosis involved reduced blood flow in bones of the joints.
A retrospective cohort study was conducted to evaluate this risk of glucocorticoids in adults & children with autoimmune problems. The participants diagnosed with inflammatory problems such as asthma; juvenile, psoriatic or rheumatoid arthritis; systemic lupus; inflammatory bowel disease or psoriasis were considered for analysis. The Population-representative data from general practices in the UK from 1994 to 2013 was taken for evaluation. The study involved primary (osteonecrosis) and secondary ( osteonecrosis plus symptoms, pain medication, surgical repair) endpoints. The hazard ratio (aHR) of incident osteonecrosis following oral glucocorticoid exposure was measured via Discrete time failure models. As glucocorticoids were rarely protective, the hypothesis testing during the study was one-sided.
The relationship of glucocorticoid with osteonecrosis was seen among adults after adjusting demographic, disease-related and health utilization factors. Adults from age 18-49 exhibited the association. But patients did not exhibit any glucocorticoid- osteonecrosis relationship if the glucocorticoid dose was low. The low-dose of glucocorticoids for adults decided was correspond to average doses <7.5 mg prednisolone daily and maximum doses <30 mg daily. On the other hand, the children of age 2-9 exhibited no evidence of increased osteonecrosis, even at high doses of glucocorticoid. The patients with the problem of arthritis, lupus & inflammatory bowel disease showed no evidence of osteonecrosis. However, adults with low-risk and high-risk of diseases displayed an identical dose relationship between glucocorticoids and osteonecrosis.
A clear relationship of glucocorticoids with osteonecrosis among adults can be
seen from the overall studies. No risk was noticed among children. The lower
doses of glucocorticoids exhibited a very small risk of osteonecrosis among
both children & adults.
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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