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Effects of Systemic Glucocorticoid Use on Fracture Risk: A Population-Based Study

Endocrinology and Metabolism 2020년 35권 3호 p.562 ~ 570
고지원, 김준강, 조혜민, 하용찬, 김태영, 이영균, 김하영, 장선미,
소속 상세정보
고지원 ( Koh Ji-Weon ) - Inhu-Chongno Pharmacy
김준강 ( Kim Jun-Kang ) - Mediplex Sejong Hospital Department of Pharmacy
조혜민 ( Cho Hye-Min ) - Gachon University College of Pharmacy
하용찬 ( Ha Yong-Chan ) - Chung-Ang University College of Medicine Department of Orthopaedic Surgery
김태영 ( Kim Tae-Young ) - Konkuk University School of Medicine Konkuk University Medical Center Department of Orthopaedic Surgery
이영균 ( Lee Young-Kyun ) - Seoul National University Bundang Hospital Department of Orthopaedic Surgery
김하영 ( Kim Ha-Young ) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Internal Medicine
장선미 ( Jang Sun-Mee ) - Gachon University College of Pharmacy

Abstract


Background: Long-term glucocorticoid use increases fracture risk by reducing bone mass. This study evaluated the relationship between hip and vertebral fractures and the total amount of systematic glucocorticoid use.

Methods: We randomly selected 1,896,159 people aged 20 to 100 years who participated in the National Health Checkup program in 2006. The amount of glucocorticoids prescribed was calculated based on the defined daily dose (DDD). The total DDD was obtained by adding oral and parenteral glucocorticoids for 6 months from the index date. Subjects were categorized into four groups according to total glucocorticoid DDDs: non-users (DDDs=0), low users (0< DDDs ≤45), intermediate users (45< DDDs ≤90), and high users (90< DDDs). We followed them for 2 years. A multivariate Cox proportional hazard model was used to evaluate the effects of the total amount of glucocorticoid use on hip and vertebral fractures.

Results: Higher glucocorticoid use was associated with a higher risk of vertebral fracture. Relative to non-users, the vertebral fracture risk was 1.39 times higher in the low-user group, 1.94 times higher in the intermediate-user group, and 2.43 times higher in the highuser group. The risk of hip fracture was 1.72 times higher in intermediate users and 3.28 times higher in high users than in non-users.

Conclusion: As the amount of glucocorticoid use for 6 months increased, the risk of hip and vertebral fractures became higher. In order to prevent fractures, it is necessary for doctors to evaluate the total amount of glucocorticoid prescribed to the patient and to provide appropriate treatment.

키워드

Glucocorticoids; Fracture; Epidemiologic studies; Osteoporosis

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