A simple score for estimating the long-term risk of fracture in patients using oral glucocorticoids.
BACKGROUND
Previous analyses of risk factors for glucocorticoid (GC)-induced osteoporosis have focused on the estimation of relative rather than absolute fracture probability.


OBJECTIVE
To estimate risk scores for the individual probability of fracture in GC users.


METHODS
Retrospective data analysis.


METHODS
We evaluated all patients aged 40 years or older with a prescription for oral GCs in the General Practice Research Database (GPRD), which comprises the computerized medical records of around 7 million UK subjects. Individual risk factors for osteoporotic fractures were identified, and combined in a predictive model for 10-year absolute fracture risk.


RESULTS
Of 191 752 oral GC users aged > or =40 years, 7412 experienced an osteoporotic fracture. Several characteristics independently contributed to the fracture risk score (GC therapy, age, gender, fall history, fracture history, body mass index, smoking, previous diagnoses, use of medication, recent hospitalization and indication for GC treatment). Scores of 30, 40 and 50 corresponded to absolute 5-year fracture risks of 6.2%, 15.3% and 35.2%, respectively. A woman aged 65 years with RA, low BMI, and a previous history of fracture and falls, who used 15 mg GC daily (total risk score 54) would have a 5-year fracture risk of 47% (a man with similar history, 30.1%). Short-term use of high-dose GC therapy (> or =30 mg) was associated with only a small increased risk of osteoporotic fracture (RR 1.21, 95%CI 1.04-1.42) in patients with a history of GC use.


CONCLUSIONS
This risk score helps to predict an individual's risk of fracture during GC use. Decisions about bone protection treatment could be based on long-term risks of fracture.
van Staa
T-P
TP
Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
Geusens
P
P
Pols
H A P
HA
de Laet
C
C
Leufkens
H G M
HG
Cooper
C
C
D000058:Accidental Falls / Q000706:statistics & numerical data; D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D004812:Epidemiologic Methods; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced* / Q000453:epidemiology; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000453:epidemiology; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology
D005938:Glucocorticoids