Osteoporosis: steroid-induced: increasing age and lower bone mineral density increased the risk

Clinical bottom line (level 2b)

  1. One in four patients on long-term corticosteroids had vertebral deformity.
  2. The risk increased with
    • increasing age
    • lower lumbar spine or femoral neck Z scores
Naganathan et al: Arch Intern Med 2000; 160 : 2917-2922
Expires May 2004

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: 4 rheumatology clinics, Australia

229 patients (aged 18 to 85; mean 61, 69% female) on continuous long-term corticosteroids (at least 6 months of prednisone 5 mg or more/daily or equivalent)

Factors studied:
  • age, sex, body mass index, duration of steroid use, bone mineral density
  • aged 70-79
  • aged 80 or more
  • falling lumbar spine BMD Z score
  • falling femoral neck Z score

All patients had lateral thoracic and lumbar spine X-rays and DEXA scanning of lumbar spine and neck of femur.


100% followed for 0.5 to 37 years: median 4.8 years

Outcomes studied:
  • at least 1 vertebral deformity
  • 2 or more fractures

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    at least 1 vertebral deformity 0.5 to 37 years: median 4.8 years 65/229 28%
    (23% to 34%)    		 4
    (3 to 4)
    2 or more fractures 0.5 to 37 years: median 4.8 years 25/229 11%
    (7% to 15%)    		 9
    (7 to 15)

    prognostic factor for
    at least 1 vertebral deformity     		time to outcome control rate (%) adjusted OR
    (95% CI)
    aged 70-79 ? 5.13
    (2.03 to 13.0)
    aged 80 or more ? 28.9
    (2.56 to 330)
    falling lumbar spine BMD Z score ? 1.31
    (1.02 to 1.68)
    falling femoral neck Z score ? 1.77
    (1.07 to 2.94)

      Citation

      1. Naganathan V, Jones G, Nash P, et al: vertebral fracture risk with long-term corticosteroid therapy: prevalence and relation to age, bone density, and corticosteriod use. Arch Intern Med 2000; 160 : 2917-2922
      Search Terms:
      Contributor: Chris Ball, May 2002
      Reviewer:

      Clinical Question.
      Patient long-term corticosteroids
      Intervention or Exposure age, bone mineral density
      Outcome vertebral deformity, fractures