A meta-analysis of prior corticosteroid use and fracture risk.
Abstract
The relationship between use of corticosteroids and fracture risk was estimated in a meta-analysis of data from seven cohort studies of ∼42,000 men and women. Current and past use of corticosteroids was an important predictor of fracture risk that was independent of prior fracture and BMD. Introduction: The aims of this study were to validate that corticosteroid use is a significant risk factor for fracture in an international setting and to explore the effects of age and sex on this risk. Materials and Methods: We studied 42,500 men and women from seven prospectively studied cohorts followed for 176,000 patient-years. The cohorts comprised the EPOS/EVOS study, CaMos, the Rotterdam Study, Dubbo Osteoporosis Epidemiology Study (DOES), and prospective cohorts at Sheffield, Rochester, and Gothenburg. The effect of ever use of corticosteroids, BMD, age, and sex on all fracture, osteoporotic fracture, and hip fracture risk alone was examined using Poisson regression in each cohort and for each sex. The results of the different studies were merged from the weighted β coefficients. Results: Previous corticosteroid use was associated with a significantly increased risk of any fracture, osteoporotic fracture, and hip fracture when adjusted for BMD. Relative risk of any fracture ranged from 1.98 at the age of 50 years to 1.66 at the age of 85 years. For osteoporotic fracture, the range of relative risk was 2.63-1.71, and for hip fracture 4.42-2.48. The estimate of relative risk was higher at younger ages, but not significantly so. No significant difference in risk was seen between men and women. The risk was marginally and not significantly upwardly adjusted when BMD was excluded from the model. The risk was independent of prior fracture. In the three cohorts that documented current corticosteroid use, BMD was significantly reduced at the femoral neck, but fracture risk was still only partly explained by BMD. Conclusion: We conclude that prior and current exposure to corticosteroids confers an increased risk of fracture that is of substantial importance beyond that explained by the measurement of BMD. Its identification on an international basis validates the use of this risk factor in case-finding strategies.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The most universally described skeletal consequence of glucocorticoid therapy is reduction in BMD, which can lead to increased fracture risk.
“The most universally described skeletal consequence of glucocorticoid therapy is a reduction in BMD, which can lead to increased fracture risk (243-245).”
From Receptor Activator of Nuclear Factor κB Ligand and Osteoprotegerin Regulation of Bone Remodeling in Health and Disease (2008) · cites this paper as [245]
Cites
Diagnosis of osteoporosis and assessment of fracture risk
Kanis, J. А. (2002) · The Lancet · doi:10.1016/s0140-6736(02)08761-5 · Cited by 2,266 · see citing works
Self-citationThe epidemiology of corticosteroid-induced osteoporosis: a meta-analysis
Staa, T. P. V., Staa, T. P. V., Staa, T. P. V., Leufkens, H. G. M., & Cooper, C. (2002) · Osteoporosis International · doi:10.1007/s001980200108 · Cited by 1,294 · see citing works
Determinants of disease and disability in the elderly: The Rotterdam elderly study
Albert Hofman, D., Grobbee, D. E., de Jong, P. T. V. M., & Ouweland, F. A. V. D. (1991) · European Journal of Epidemiology · doi:10.1007/bf00145007 · Cited by 1,129 · see citing works
O’Neill, T. W., Felsenberg, D., Varlow, J., Cooper, C. C., Kanis, J. A., Silman, A. J., & The European Vertebral Osteoporosis Study Group (1996) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650110719 · Cited by 957 · see citing works
Self-citationRecommendations for the prevention and treatment of glucocorticoid‐induced osteoporosis
American College of Rheumatology task force on Osteoporosis guidelines (1996) · Arthritis & Rheumatism · doi:10.1002/art.1780391104 · Cited by 848 · see citing works
Guidelines for diagnosis and management of osteoporosis
Kanis, J. А., Delmas, P. D., Burckhardt, P., Cooper, C. C., & Torgerson, D. J. (1997) · Osteoporosis International · doi:10.1007/bf01623782 · Cited by 789 · see citing works
Self-citationThe Burden of Osteoporotic Fractures: A Method for Setting Intervention Thresholds
Kanis, J. А., Odén, A., Johnell, O., Jönsson, B., Laet, C. E. D. H. D., & Dawson, A. H. (2001) · Osteoporosis International · doi:10.1007/s001980170112 · Cited by 721 · see citing works
Self-citationO'Neill, D. D. A. M. G. A. J. W. D. L. A. A. J. C. J. R. B. W. S. K. I. J. O. J. G. V. A. R. G. P. C. T. G. H. G. H. D. W. N. J. C. K. A. O. J. T. W. F. S. L. A. I. F. C. B. B. B. B. C. C. D. E. F. G. H. H. J. J. J. K. K. L. L. L. M. M. M. P. P. P. R. R. R. S. S. T. W. W. Y. R. (2002) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2002.17.4.716 · Cited by 713 · see citing works
Oral corticosteroids and fracture risk: relationship to daily and cumulative doses
van Staa, T. P., Leufkens, H. G. M., Abenhaim, L., Zhang, B., & Cooper, C. C. (2000) · Lara D. Veeken · doi:10.1093/rheumatology/39.12.1383 · Cited by 699 · see citing works
Bone Density and Fracture Risk in Men
Melton, L. J., Atkinson, E. J., O’Connor, M. K., O'Fallon, W. M., & Riggs, B. L. (1998) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.1998.13.12.1915 · Cited by 685 · see citing works
Self-citationJones, G., Nguyen, T. V., Sambrook, P. N., Kelly, P. J., Gilbert, C., & Eisman, J. A. (1994) · Osteoporosis International · doi:10.1007/bf01623352 · Cited by 484 · see citing works
Self-citationRheumatoid arthritis, corticosteroid therapy and hip fracture.
Cooper, C. C., Coupland, C. A. C., & Mitchell, M. (1995) · Annals of the Rheumatic Diseases · doi:10.1136/ard.54.1.49 · Cited by 354 · see citing works
Schott, A., Cormier, C., Hans, D., Favier, F., Hausherr, E., Dargent‐Molina, P., Delmas, P. D., Ribot, C. A., Sebert, J. L., Bréart, G., et al. (1998) · Osteoporosis International · doi:10.1007/s001980050061 · Cited by 353 · see citing works
Hip Fracture Prediction in Elderly Men and Women: Validation in the Rotterdam Study
Laet, C. E. D. H. D., van Hout, B. A., Burger, H., Weel, A. E. A. M., Albert Hofman, D., & Pols, H. A. P. (1998) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.1998.13.10.1587 · Cited by 331 · see citing works
Self-citationA UK Consensus Group on management of glucocorticoid‐induced osteoporosis: an update
Eastell, R., Reid, D. M., Compston, J. E., Cooper, C. C., Fogelman, I., Francis, R. M., Hosking, D. J., Purdie, D. W., Ralston, S. H., REEVE, J., et al. (1998) · Journal of Internal Medicine · doi:10.1046/j.1365-2796.1998.00408.x · Cited by 307 · see citing works
Self-citationFractures after rheumatoid arthritis a population‐based study
Hooyman, J. R., Melton, L. J., Nelson, A. M., O’Fallon, W. M., & Riggs, B. L. (1984) · Arthritis & Rheumatism · doi:10.1002/art.1780271205 · Cited by 283 · see citing works
Self-citationIsmail, A., Pye, S. R., Cockerill, W., Lunt, M., Silman, A. J., REEVE, J., Banzer, D., Benevolenskaya, L. I., Bhalla, A., Bruges‐Armas, J., et al. (2002) · Osteoporosis International · doi:10.1007/s001980200074 · Cited by 227 · see citing works
Self-citationResearch Notes: The Canadian Multicentre Osteoporosis Study (CaMos): Background, Rationale, Methods
Kreiger, N., Tenenhouse, A., Joseph, L., MacKenzie, T. C., Poliquin, S., Brown, J. P., Prior, J. C., & Rittmaster, R. S. (1999) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1017/s0714980800009934 · Cited by 220 · see citing works
Self-citationAltered trabecular architecture induced by Corticosteroids: A Bone Histomorphometric Study
Chappard, D., Legrand, É., Baslé, M. F., Fromont, P., Racineux, J.-L., Rebel, A., & Audran, M. (1996) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650110516 · Cited by 191 · see citing works
Bone Mineral Density Is a Predictor of Survival
Johansson, C., Black, D. M., Johnell, O., Odén, A., & Mellström, D. (1998) · Calcified Tissue International · doi:10.1007/s002239900513 · Cited by 164 · see citing works
Self-citationOptimization of BMD Measurements to Identify High Risk Groups for Treatment—A Test Analysis
Johansson, H., Odén, A., Johnell, O., Jönsson, B., Laet, C. E. D. H. D., Oglesby, A. K., McCloskey, E. V., Kayan, K., Jalava, T., & Kanis, J. А. (2004) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2004.19.6.906 · Cited by 149 · see citing works
Self-citationMelton, L. J., Crowson, C. S., O’Fallon, W. M., Wahner, H. W., & Riggs, B. L. (2003) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2003.18.2.312 · Cited by 138 · see citing works
Self-citationCorticosteroids and Fractures: A Close Encounter of the Third Cell Kind
Manolagas, S. C. (2000) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2000.15.6.1001 · Cited by 135 · see citing works
Contrasting Microanatomy of Idiopathic and Corticosteroid-Induced Osteoporosis
Aaron, J. E., Francis, R. M., Peacock, M., & Makins, N. B. (1989) · Clinical Orthopaedics and Related Research · doi:10.1097/00003086-198906000-00044 · Cited by 116 · see citing works
Guidelines for prevention and treatment of glucocorticoid-induced osteoporosis
Compston, J. E. (2009) · Bone · doi:10.1016/j.bone.2009.07.039 · Cited by 39 · see citing works
Santiago (2001) · doi:10.1002/1529-0131(200107)44:7
Flagged first, then by citations
Cited by
Sorted by citations
Sipuleucel-T Immunotherapy for Castration-Resistant Prostate Cancer
Kantoff, P. W., Higano, C. S., Shore, N. D., Berger, E. R., Small, E. J., Penson, D. F., Redfern, C. H., Ferrari, A. C., Dreicer, R., Sims, R. B., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1001294 · Cited by 5,572 · see citing works
FRAX™ and the assessment of fracture probability in men and women from the UK
Kanis, J. A., Johnell, O., Oden, A., Johansson, H., & McCloskey, E. (2008) · Osteoporosis International · doi:10.1007/s00198-007-0543-5 · Cited by 2,467 · see citing works
Self-citationTeriparatide or Alendronate in Glucocorticoid-Induced Osteoporosis
Saag, K. G., Shane, E., Boonen, S., Marín, F., Donley, D. W., Taylor, K. A., Dalsky, G. P., & Marcus, R. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa071408 · Cited by 914 · see citing works
International Consensus Statement on Allergy and Rhinology: Rhinosinusitis
Orlandi, R. R., Kingdom, T. T., Hwang, P. H., Smith, T. L., Alt, J. A., Baroody, F. M., Batra, P. S., Bernal‐Sprekelsen, M., Bhattacharyya, N., Chandra, R. K., et al. (2016) · International Forum of Allergy & Rhinology · doi:10.1002/alr.21695 · Cited by 892 · see citing works
Kearns, A. E., Khosla, S., & Kostenuik, P. J. (2008) · Endocrine Reviews · doi:10.1210/er.2007-0014 · Cited by 824 · see citing works
UK clinical guideline for the prevention and treatment of osteoporosis
Gregson, C. L., Armstrong, D. J., Bowden, J., Cooper, C., Edwards, J., Gittoes, N. J. L., Harvey, N., Kanis, J., Leyland, S., Low, R., et al. (2022) · Archives of Osteoporosis · doi:10.1007/s11657-022-01061-5 · Cited by 593 · see citing works
Self-citationThe role of DXA bone density scans in the diagnosis and treatment of osteoporosis
Blake, G. M., & Fogelman, I. (2007) · Postgraduate Medical Journal · doi:10.1136/pgmj.2007.057505 · Cited by 532 · see citing works
Saag, K. G., Zanchetta, J. R., Devogelaer, J., Adler, R. A., Eastell, R., See, K., Krege, J. H., Krohn, K., & Warner, M. R. (2009) · Arthritis & Rheumatism · doi:10.1002/art.24879 · Cited by 493 · see citing works
A meta-analysis of the association of fracture risk and body mass index in women
Johansson, H., Kanis, J. A., Odén, A., McCloskey, E., Chapurlat, R. D., Christiansen, C., Cummings, S. R., Diez-Perez, A., Eisman, J. A., Fujiwara, S., et al. (2014) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.2017 · Cited by 480 · see citing works
Self-citationImplications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA
Dawson-Hughes, B., Tosteson, A. N. A., Melton, L. J., Baim, S., Favus, M. J., Khosla, S., & Lindsay, R. L. (2008) · Osteoporosis International · doi:10.1007/s00198-008-0559-5 · Cited by 427 · see citing works
Self-citationPrevalence of oral glucocorticoid usage in the United States: a general population perspective
Overman, R. A., Yeh, J., & Deal, C. L. (2013) · Arthritis Care & Research · doi:10.1002/acr.21796 · Cited by 405 · see citing works
Determinants of Muscle and Bone Aging
Curtis, E., Litwic, A., Cooper, C., & Dennison, E. (2015) · Journal of Cellular Physiology · doi:10.1002/jcp.25001 · Cited by 375 · see citing works
Glucocorticoid-induced osteoporosis
Briot, K., & Roux, C. (2015) · RMD Open · doi:10.1136/rmdopen-2014-000014 · Cited by 300 · see citing works
Factors associated with the lumbar spine and proximal femur bone mineral density in older men
Cauley, J. A., Fullman, R. L., Stone, K. L., Zmuda, J. M., Bauer, D. C., Barrett-Connor, E., Ensrud, K., Lau, E. M. C., Orwoll, E. S., & For the Mr. OS Research Group (2005) · Osteoporosis International · doi:10.1007/s00198-005-1866-8 · Cited by 258 · see citing works
Cheen, M. H. H., Tan, Y. Z., Oh, L. F., Wee, H. L., & Thumboo, J. (2019) · International Journal of Clinical Practice · doi:10.1111/ijcp.13350 · Cited by 175 · see citing works
Glüer, C.-C., Marin, F., Ringe, J. D., Hawkins, F., Möricke, R., Papaioannu, N., Farahmand, P., Minisola, S., Martínez, G., Nolla, J. M., et al. (2013) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.1870 · Cited by 171 · see citing works
Glucocorticoids and bone: Local effects and systemic implications
Henneicke, H., Gasparini, S. J., Brennan-Speranza, T. C., Zhou, H., & Seibel, M. J. (2014) · Trends in Endocrinology & Metabolism · doi:10.1016/j.tem.2013.12.006 · Cited by 168 · see citing works
Utility of the trabecular bone score (TBS) in secondary osteoporosis
Ulivieri, F. M., Silva, B. C., Sardanelli, F., Hans, D., Bilezikian, J. P., & Caudarella, R. (2014) · Endocrine · doi:10.1007/s12020-014-0280-4 · Cited by 161 · see citing works
Patient Adherence to Osteoporosis Medications: Problems, Consequences and Management Strategies
Papaioannou, A., Kennedy, C. C., Dolovich, L., Lau, E., & Adachi, J. D. (2007) · Drugs & Aging · doi:10.2165/00002512-200724010-00003 · Cited by 151 · see citing works
The effects of Tai Chi on bone mineral density in postmenopausal women: a systematic review
Wayne, P. M., Kiel, D. P., Krebs, D. E., Davis, R. B., Savetsky-German, J., Connelly, M., & Buring, J. E. (2007) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2007.02.012 · Cited by 113 · see citing works
STOCH, S. A., SAAG, K. G., GREENWALD, M., SEBBA, A. I., COHEN, S., VERBRUGGEN, N., GIEZEK, H., WEST, J., & SCHNITZER, T. J. (2009) · The Journal of Rheumatology · doi:10.3899/jrheum.081207 · Cited by 100 · see citing works
Subclinical Thyroid Dysfunction and the Risk for Fractures: A Systematic Review and Meta-analysis
Wirth, C. D., Blum, M. R., da Costa, B. R., Baumgartner, C., Collet, T.-H., Medici, M., Peeters, R. P., Aujesky, D., Bauer, D. C., & Rodondi, N. (2014) · Annals of Internal Medicine · doi:10.7326/m14-0125 · Cited by 85 · see citing works
Understanding and managing corticosteroid-induced osteoporosis
Kobza, A. O., Herman, D., Papaioannou, A., Lau, A. N., & Adachi, J. D. (2021) · Open Access Rheumatology Research and Reviews · doi:10.2147/oarrr.s282606 · Cited by 84 · see citing works
The relationship between bone mineral density and fracture risk
McClung, M. R. (2005) · Current Osteoporosis Reports · doi:10.1007/s11914-005-0005-y · Cited by 77 · see citing works
Glucocorticoid-induced osteoporosis
Silverman, S. L., & Lane, N. E. (2009) · Current Osteoporosis Reports · doi:10.1007/s11914-009-0005-4 · Cited by 50 · see citing works
Osteoporosis Imaging in the Geriatric Patient
Heilmeier, U., Youm, J., Torabi, S., & Link, T. M. (2016) · Current Radiology Reports · doi:10.1007/s40134-016-0144-1 · Cited by 21 · see citing works
Kaji, H., Kuroki, Y., Murakawa, Y., Funakawa, I., Funasaka, Y., Kanda, F., & Sugimoto, T. (2010) · Osteoporosis International · doi:10.1007/s00198-009-1110-z · Cited by 16 · see citing works
- Authors
- Kanis, J. A., Johansson, H., Oden, A., Johnell, O., de Laet, C., Melton, L. J., Tenenhouse, A., Reeve, J., Silman, A. J., Pols, H. A., Eisman, J. A., McCloskey, E. V., & Mellstrom, D.
- Affiliations
- Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Sheffield, United Kingdom
- Consulting Statistician, Gothenburg, Sweden
- Department of Orthopaedics, Malmo General Hospital, Malmo, Sweden
- Institute for Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Mayo Clinic (US)
- Montreal General Hospital (CA)
- Strangeway's Research Laboratory, Wort's Causeway, Cambridge, United Kingdom
- University of Manchester (GB)
- Erasmus University Rotterdam (NL)
- Garvan Institute of Medical Research (AU)
- University of Sheffield (GB)
- Department of Geriatric Medicine, Goteborg University, Gothenburg, Sweden
- Venue
- Journal of Bone and Mineral Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-06-01
- Volume
- 19
- Issue
- 6
- Pages
- 893-899
- ISSN
- 0884-0431 (ISSN-L)
- 1523-4681
- OpenAlex
- W1983391342
- Cited by
- 839
- References
- 26
- Citations by year
- 2026: 17 · 2025: 29 · 2024: 29 · 2023: 29 · 2022: 36 · 2021: 32 · 2020: 38 · 2019: 28 · 2018: 27 · 2017: 34 · 2016: 35 · 2015: 43 · 2014: 37 · 2013: 46 · 2012: 38
- FWCI
- 8.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of Bone and Mineral Research (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Chalmers Publication Library (Chalmers University of Technology) (submittedVersion)
- Chalmers Research (Chalmers University of Technology) (submittedVersion)
- Funders
- Eli Lilly and Company
- International Osteoporosis Foundation
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- corticosteroid use, fracture risk, osteoporotic fractures, hip fracture, bone mineral density, age and sex differences, osteoporosis risk factors, case finding
- MeSH terms
- Adrenal Cortex Hormones, Aged, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Fractures, Bone
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
