Incidence and risk factors for corticosteroid-induced lipodystrophy: a prospective study.
BACKGROUND
Very few studies have focused on fat redistribution induced by corticosteroids.


OBJECTIVE
To establish the incidence and risk factors of facial ("moon face") and cervical ("buffalo hump") lipodystrophy due to long-term (> or =3 months), high dosage (>or =20 mg/d) systemic corticosteroid therapy.


METHODS
Between June 2003 and May 2005 we conducted a prospective study in two French tertiary centers. All consecutive patients starting long-term systemic corticosteroid therapy at an initial daily dosage of 20 mg or more were enrolled in this study. Three investigators assessed the development of facial and cervical corticosteroid-induced lipodystrophy (CIL) from standardized photographs. Demographic, clinical, and nutritional data were examined to assess risk factors of CIL.


RESULTS
Eighty-eight patients were enrolled (women: 75%, mean age: 57.4 +/- 17.9 years, mean baseline dosage of prednisone: 56 +/- 15 mg/d). The cumulative incidence rate of CIL at months 3 and 12 was 61% +/- 8% and 69% +/- 9%, respectively. In multivariate analyses the risk of CIL at the third month was higher in women (odds ratio [OR]: 10.87 [2.43-58.82]), in subjects younger than 50 years of age (OR: 11.11 [2.19-37.89]), in subjects with a high initial body mass index (OR: 1.56 [1.21-2.03] per increment of 1 kg/m2) and in subjects with high energy intake (OR: 6.11 [1.35-27.75] when higher than 30 kcal/d/kg).


CONCLUSIONS
Photographic analysis is not a conventional method for the diagnosis of CIL.


CONCLUSIONS
CIL frequently occurs, especially in overweight subjects and in women, who are also at higher risk to develop other forms of lipodystrophies.
Fardet
Laurence
L
Department of Internal Medicine, Hôpital Saint-Antoine, Paris, France. laurence.fardet@sat.aphp.fr
Cabane
Jean
J
Lebbé
Céleste
C
Morel
Patrice
P
Flahault
Antoine
A
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008060:Lipodystrophy / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010781:Photography; D011446:Prospective Studies; D012307:Risk Factors
D005938:Glucocorticoids