Vestergaard P, Olsen M L, Paaske Johnsen S, Rejnmark L, Sørensen H Toft, Mosekilde L
Department of Endocrinology and Metabolism C, Aarhus Amtssygehus, Aarhus University Hospital, Aarhus, Denmark.
J Intern Med. 2003 Nov;254(5):486-93. doi: 10.1046/j.1365-2796.2003.01219.x.
To examine the association between cumulative CS dose and risk of hip fracture.
Population-based case-control design.
A total of 6660 subjects with hip fracture and 33,272 age-matched population controls were identified using the County Hospital Discharge Registry in North Jutland County, Denmark and the Danish Central Personal Registry, respectively. Data on redeemed prescriptions for CS within the last 5 years before the index date were retrieved from a population-based prescription database, and recalculated to prednisolone equivalents. Cases and controls were categorized according to cumulative CS dose: (i) no use; (ii) <130 mg (e.g. equivalent to 30 mg of prednisolone for 4 days given for an acute exacerbation of asthma); (iii) 130-499 mg (e.g. equivalent to a short course of prednisolone of 450 mg for acute asthma); (iv) 500-1499 mg (e.g. equivalent to 7.5 mg prednisolone daily for 6 months or 800 microg day(-1) of inhaled budesonide for 1 year); and (v) > or =1500 mg (e.g. equivalent to >4.1 mg day(-1) for 1 year, a long-term high dose). Data were analysed using conditional logistic regression adjusted for potential confounders including gender, redeemed prescriptions for hormone replacement therapy, antiosteoporotic, anxiolytic, antipsychotic and antidepressant drugs.
Compared with never users, an increased risk of hip fracture was found for CS users, with increasing cumulative doses of any type of CS use during the preceding 5 years [adjusted odds ratio (OR)=0.96, 95% confidence interval (CI)=0.89-1.04] for <130 mg prednisolone; OR=1.17 (CI=1.01-1.35) for 130-499 mg; OR=1.36 (CI=1.19-1.56) for 500-1499 mg; and OR=1.65 (CI=1.43-1.92) for > or =1500 mg. An increased risk was also found when the study population was stratified according to gender, age and type of CS (systemic or topical).
Even a limited daily dose of CS (more than an average dose of approximately 71 microg prednisolone per day) was associated with an increased risk of hip fracture.
研究累积使用皮质类固醇（CS）剂量与髋部骨折风险之间的关联。
基于人群的病例对照研究设计。
分别利用丹麦北日德兰郡的县医院出院登记处和丹麦中央个人登记处，确定了6660例髋部骨折患者及33272例年龄匹配的人群对照。从一个基于人群的处方数据库中检索索引日期前最后5年内CS的已兑现处方数据，并重新计算为泼尼松龙等效剂量。病例和对照根据累积CS剂量进行分类：（i）未使用；（ii）<130毫克（例如，相当于哮喘急性加重时给予4天的30毫克泼尼松龙）；（iii）130 - 499毫克（例如，相当于急性哮喘短期使用450毫克泼尼松龙）；（iv）500 - 1499毫克（例如，相当于每日7.5毫克泼尼松龙使用6个月或每日800微克吸入布地奈德使用1年）；以及（v）≥1500毫克（例如，相当于>4.1毫克/天使用1年，长期高剂量）。使用条件逻辑回归分析数据，并对包括性别、激素替代疗法、抗骨质疏松、抗焦虑、抗精神病和抗抑郁药物的已兑现处方等潜在混杂因素进行调整。
与从未使用者相比，发现CS使用者髋部骨折风险增加，在前5年中任何类型CS的累积剂量增加时，<130毫克泼尼松龙的调整优势比（OR）=0.96，95%置信区间（CI）=0.89 - 1.04；130 - 499毫克时OR = 1.17（CI = 1.01 - 1.35）；500 - 1499毫克时OR = 1.36（CI = 1.19 - 1.56）；≥1500毫克时OR = 1.65（CI = 1.43 - 1.92）。当根据性别、年龄和CS类型（全身或局部）对研究人群进行分层时，也发现风险增加。
即使是有限的每日CS剂量（超过平均每日约71微克泼尼松龙剂量）也与髋部骨折风险增加相关。
