Age dependence of early symptomatic vertebral fracture with high-dose glucocorticoid treatment for collagen vascular diseases.
OBJECTIVE
Collagen vascular diseases requiring treatment with high-dose glucocorticoids are frequently complicated by vertebral fracture. We investigated the incidence of symptomatic vertebral fractures for 20 yr among patients who were treated with high-dose glucocorticoids in the Chiba-Shimoshizu Rheumatic Cohort.


METHODS
A total of 2631 patients with collagen vascular diseases (aged >or=18 yr) was registered between 1986 and 2006. The prevalence of symptomatic vertebral fracture was compared between the high-dose glucocorticoid group newly treated with high-dose glucocorticoids (>or=20 mg/d prednisolone equivalent) (n = 700), and the non-glucocorticoid controls not treated with glucocorticoids (n = 194).


RESULTS
During the 20-yr study period, symptomatic vertebral fractures occurred more frequently in the high-dose glucocorticoid group (23.9%) than in the non-glucocorticoid controls (2.6%). According to a Kaplan-Meier analysis, the cumulative incidence of symptomatic vertebral fracture was significantly higher in the high-dose glucocorticoid group than in the non-glucocorticoid controls (P < 0.001). Stratified into age quartiles of the high-dose glucocorticoid group (age 18-31, 32-47, 48-59, and 60-88 yr), the patients had a markedly increased incidence of symptomatic vertebral fracture with aging. The hazard ratios were also significantly higher in the older age quartile of 60-68 than in the younger age quartile of 32-47 (P < 0.001 for trend). The hazard ratio was 26-fold higher in patients aged 60-88 than in patients aged 18-31 (P < 0.01). In the group with fractures, the treatment duration before fracture was negatively associated with the initial age (r = -0.6587; P < 0.001).


CONCLUSIONS
The prevalence of symptomatic vertebral fractures was higher in the patients treated with high-dose glucocorticoids than the untreated controls. Vertebral fractures were age dependent in patients treated with high-dose glucocorticoids. Treatment duration before fracture incidence was significantly shorter in the older patients.
Tatsuno
Ichiro
I
Department of Clinical Cell Biology, Chiba University Graduate School of Medicine, Japan. ichiro-tatsuno@faculty.chiba-u.jp
Sugiyama
Takao
T
Suzuki
Sawako
S
Yoshida
Tomohiko
T
Tanaka
Tomoaki
T
Sueishi
Makoto
M
Saito
Yasushi
Y
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003095:Collagen Diseases / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D013124:Spinal Injuries / Q000453:epidemiology* / Q000209:etiology*; D013131:Spine; D014652:Vascular Diseases / Q000150:complications* / Q000188:drug therapy; D055815:Young Adult
D005938:Glucocorticoids