1. Among a large cohort of Danish adults, the use of potent or very potent topical corticosteroids was found to be associated with an increased risk of osteoporosis and major osteoporotic fracture.
Evidence Level Rating: 2 (Good)
It is well established that in their systemic and inhaled forms, corticosteroids have a negative impact on bone remodeling, increasing the risk of fracture and osteoporosis when given continuously or in high doses. The use of topical corticosteroids (TCSs) can also have negative systemic effects; however, whether their use increases the risk of osteoporosis and major osteoporotic fracture (MOF) is largely unknown. This nationwide retrospective cohort study from Denmark included 723,251 adults (mean [SD] age = 52.8 [19.2] years, 52.8% female) treated with either potent or very potent TCSs. Filled prescription data were converted in equipotent doses to mometasone furoate (1 mg/g). Included participants were treated with the equivalent of at least 200 g of mometasone. The primary outcome was a diagnosis of osteoporosis or MOF. 25.8% of participants were exposed to 500-999 g of mometasone; 15.4% to 1,000-1,999 g; 13.0% to 2,000-9,999 g; and 1.9% to at least 10,000 g. After adjustment, exposure (≥ 500 g vs. 200-499 g) to potent or very potent TCSs was significantly associated with an increased risk of both osteoporosis (HR 1.08, 95% CI 1.05 to 1.11) and MOF (HR 1.05, 95% CI 1.03 to 1.07). The risk of both osteoporosis and MOF was found to increase in a dose-dependent manner. In all, the population-attributable risk was found to be 4.3% (95% CI 2.7% to 5.8%) for osteoporosis and 2.7% (95% CI 1.7% to 3.8%) for MOF. This study demonstrated that the use of high cumulative amounts of potent or very potent TCSs was associated with an increased risk of both osteoporosis and MOF. Given the widespread use of TCSs worldwide, such findings are of public health importance and should help inform new treatment strategies.
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