Soen Orthopaedics, Osteoporosis and Rheumatology Clinic, Kobe, Japan.
Primary Medical Science Department, Medical Affairs Division, Japan Business Unit, Daiichi Sankyo Co. Ltd, 3-5-1, Nihonbashi Honcho, Chuo-ku, Tokyo, 103-8426, Japan.
J Bone Miner Metab. 2022 Jul;40(4):636-647. doi: 10.1007/s00774-022-01325-7. Epub 2022 May 11.
Glucocorticoid-induced osteoporosis (GIOP) is associated with elevated fracture risk. Practice guidelines have been published to reduce this risk but are insufficiently followed in everyday practice. The objectives of this study were to estimate fracture incidence in patients exposed to oral glucocorticoids and to analyse the impact of glucocorticoid use on fracture incidence.
This retrospective cohort study was performed using the Medical Data Vision (MDV) claims database from Japan. All patients aged ≥ 18 years initiating oral glucocorticoids and fulfilling Japanese guideline criteria for starting prophylactic osteoporosis treatment between 2009 and 2019 were identified. These were matched to a cohort of unexposed controls using propensity score matching. Fracture incidence in the two cohorts were compared using a Fine-Gray proportional sub-distribution hazard model.
13,090 glucocorticoid-exposed cases were compared to 13,090 unexposed controls. The 1-year fracture rate (all sites) was 9.3 [95% CI 8.8-9.8] in cases and 5.8 [5.4-6.2] in controls. One-year vertebral fracture rates were 4.3 [4.0-4.7] and 2.3 [2.1-2.6] respectively. In the multivariate analysis, the use of glucocorticoids was associated with an increase in the incidence of osteoporotic fractures (hazard ratio: 1.63 [1.51-1.76]). The glucocorticoid-associated risk tended to be higher in subgroups of patients with rheumatoid arthritis, asthma, COPD and in those aged < 65 years.
Oral glucocorticoid use is associated with an increase in fracture incidence. It is necessary to raise awareness of GIOP and to take public health measures to change the perceptions and behaviour of doctors prescribing glucocorticoids.
糖皮质激素诱导的骨质疏松症（GIOP）与骨折风险增加有关。已发布实践指南以降低这种风险，但在日常实践中并未得到充分遵循。本研究的目的是估计接受口服糖皮质激素治疗的患者的骨折发生率，并分析糖皮质激素使用对骨折发生率的影响。
这项回顾性队列研究使用了来自日本的 Medical Data Vision（MDV）索赔数据库。所有 2009 年至 2019 年期间年龄≥18 岁并符合开始预防性骨质疏松症治疗的日本指南标准的开始口服糖皮质激素治疗的患者均被确定为研究对象。使用倾向评分匹配将这些患者与未暴露于对照组相匹配。使用 Fine-Gray 比例亚分布风险模型比较两组的骨折发生率。
共比较了 13090 例糖皮质激素暴露病例和 13090 例未暴露对照。病例组的 1 年骨折率（所有部位）为 9.3%（95%CI 8.8-9.8），对照组为 5.8%（5.4-6.2）。1 年椎体骨折发生率分别为 4.3%（4.0-4.7）和 2.3%（2.1-2.6）。多变量分析显示，糖皮质激素的使用与骨质疏松性骨折的发生率增加相关（风险比：1.63[1.51-1.76]）。在类风湿关节炎、哮喘、COPD 患者和年龄<65 岁的患者亚组中，糖皮质激素相关风险更高。
口服糖皮质激素的使用与骨折发生率的增加有关。有必要提高对 GIOP 的认识，并采取公共卫生措施改变开具糖皮质激素的医生的观念和行为。
