title: Glucocorticoids predict 10-year fragility fracture risk in a population-based ambulatory cohort of men and women: Canadian Multicentre Osteoporosis Study (CaMos).
abstract: We determined the prospective 10-year association among incident fragility fractures and four glucocorticoid (GC) treatment groups (Never GC, Prior GC, Baseline GC, and Ever GC). Results showed that GC treatment is associated with increased 10-year incident fracture risk in ambulatory men and women across Canada.
  
  
  OBJECTIVE
  Using the Canadian Multicentre Osteoporosis Study dataset, we determined the prospective 10-year association between incident fragility fractures and GC treatment.
  
  
  METHODS
  We conducted a 10-year prospective observational cohort study at nine sites across Canada. A total of 9,263 ambulatory men and women 25 years of age and older were included in the analysis. Multivariable Cox proportional hazards analyses were conducted to determine the relationship among GC treatment groups in four levels that included Never GC, Prior GC, Baseline GC, and Ever GC (combined baseline and prior groups) and time to fracture.
  
  
  RESULTS
  In each of the Never GC, Prior GC, Baseline GC, and Ever GC treatment groups, the number of participants were 8,832 (95.4 %), 303 (3.3 %), 128 (1.4 %), and 431 (4.7 %), respectively. Of the 9,263 individuals enrolled, incident fragility non-spine, hip, spine, and any fractures were experienced by a total of 896 (9.67 %), 157 (1.69 %), 130 (1.40 %), and 1,102 (11.90 %) over 10-years, respectively. For men and women combined, prior GC treatment was associated with a higher hazard ratio (HR) for time to incident non-vertebral (HR = 1.5, 95 % confidence interval [CI] = 1.1, 2.0), hip (HR = 2.1, 95 % CI = 1.1, 4.0), and any fracture (HR = 1.4, 95 % CI = 1.0, 1.8) compared with never GC treatment.
  
  
  CONCLUSIONS
  GC treatment is associated with increased 10-year incident fracture risk; this highlights the importance of considering therapy to prevent GC-induced fractures for patients who are using GC for various medical conditions.
authors.affiliation: Faculty of Medicine, McMaster University, Hamilton, ON, Canada, g.ioannidis@sympatico.ca.
authors.forename: George
authors.initials: G
authors.lastname: Ioannidis
authors.forename: Shelley
authors.initials: S
authors.lastname: Pallan
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
authors.forename: Manisha
authors.initials: M
authors.lastname: Mulgund
authors.forename: Lorena
authors.initials: L
authors.lastname: Rios
authors.forename: Jinhui
authors.initials: J
authors.lastname: Ma
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Davison
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kovacs
authors.forename: Nancy
authors.initials: N
authors.lastname: Kreiger
authors.forename: Wojciech P
authors.initials: WP
authors.lastname: Olszynski
authors.forename: Jerilynn C
authors.initials: JC
authors.lastname: Prior
authors.forename: Tanveer
authors.initials: T
authors.lastname: Towheed
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D005598:Fractures, Spontaneous / Q000139:chemically induced* / Q000453:epidemiology; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000139:chemically induced* / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids