| pA2 online © Copyright 2004 The British Pharmacological Society |
194P
GKT, University of London Winter Meeting December 2003 |
|
Increased
prescribing for osteoporosis following exposure to glucocorticoids
particularly inhaled steroids |
|
Print abstractOral glucocorticoids are known to cause osteoporosis and systemic absorption from inhaled glucocorticoids may increase bone loss. As to whether this is clinically relevant is unclear. We determined the extent to which inhaled steroids on their own and with short courses of oral steroids is associated with increased prescribing for osteoporosis.
In a cohort study with follow-up of co-prescribing of anti-osteoporotic drug therapy in the Irish national prescribing data base (1.1m people over 16 years) we identified 32,081 patients who received inhaled steroids alone during a 12-month period (following an identical lead-in period). We determined the odds ratio (OR) for the co-prescription of bisphosphonates or other anti-osteoporotic therapy with inhaled steroids by logistic regression. Statistical analysis was performed using SAS (Version 8.02), significance at p<0.05 is assumed.
The adjusted OR (95% confidence interval) for co-prescribing of bisphosphonates and all inhaled glucocorticoids was 1.87 (1.71-2.04); 1.58(1.41-1.78) for beclomethasone and 2.48 (2.15-2.86) for more potent inhaled steroids budesonide or fluticasone. The OR were significantly increased when patients who also received oral glucocorticoids were included (OR= 4.41, 4.21-4.61) and greater still in those under 45 years on both inhaled and oral (OR=14, 10.6-18.6). A similar result was seen with other anti-osteoporotic therapies, including both specific raloxifene and non-specific calcium, Vitamin D supplements and hormone replacement therapy. The effect was more marked in men than in women.
|
Men
|
Women
|
|
| All inhaled steroids |
2.17
(1.91, 2.45)
|
1.66
(1.55, 1.77)
|
| Inhaled beclomethasone |
1.87
(1.59, 2.19)
|
1.54
(1.42, 1.66)
|
| Inhaled budesonide or fluticasone |
2.79
(2.29, 3.40)
|
1.95
(1.74, 2.18)
|
| Oral steroids only |
6.76
(6.3, 7.22)
|
3.34
(3.22, 3.46)
|
| Both inhaled and oral steroids |
6.87
(6.33, 7.45)
|
3.35
(3.19, 3.53)
|
OR of receiving bisphosphonate therapy increased linearly with increasing exposure to inhaled glucocorticoids during the study period. Exposure to short courses of oral steroids, 30 days in one year was sufficient to increase this risk.
Treatment with inhaled glucocorticoids in primary care is associated with an increased likelihood of co-prescribing for anti-osteoporotic therapy in a potency and a dose related manner. Exposure to a course of oral steroids doubles this risk.