title: Very high frequency of fragility fractures associated with high-dose glucocorticoids in postmenopausal women: A retrospective study.
abstract: Purpose To evaluate the incidence of fragility fractures associated with high-dose glucocorticoid therapy in patients with systemic rheumatic disease.
  
  
  METHODS
  A retrospective study of patients who were treated with high-dose prednisolone (> 0.8 mg/kg) for systemic rheumatic disease at Kobe University Hospital from April 1988 to March 2012. The primary outcome was a major osteoporotic fracture (defined as a clinical vertebral, hip, forearm, or proximal humerus fracture) after high-dose glucocorticoid therapy. For postmenopausal women and men over 40 of age, the patient's fracture risk at the beginning of high-dose glucocorticoid therapy was assessed by the World Health Organization's Fracture Risk Assessment Tool (FRAX®). Results Of 229 patients (median age: 49 years), 57 suffered a fragility fracture during the observation period (median observation period: 1558 days). Of 84 premenopausal patients, 5 suffered a fracture. In contrast, of 86 postmenopausal female, 36 suffered a fracture. Fragility fractures were far more frequent than predicted by the FRAX® score. Patients with FRAX® scores over 8.3% had a particularly high risk of fracture. Conclusions Fragility fractures associated with high-dose glucocorticoid therapy are common among postmenopausal women. Extreme care should be taken especially for postmenopausal women when high-dose glucocorticoid therapy is required.
authors.affiliation: Department of Rheumatology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan; Department of Rheumatology, Kobe University Hospital, Kobe, Japan.
authors.forename: Goichi
authors.initials: G
authors.lastname: Kageyama
authors.affiliation: Department of Rheumatology, Kobe University Hospital, Kobe, Japan.
authors.forename: Takaichi
authors.initials: T
authors.lastname: Okano
authors.affiliation: Department of Rheumatology, Kobe University Hospital, Kobe, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Rheumatology, Kobe University Hospital, Kobe, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sugiyama
authors.affiliation: Department of Rheumatology, Kobe University Hospital, Kobe, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Saegusa
authors.affiliation: Department of Rheumatology, Shinko Hospital, Kobe, Japan.
authors.forename: Goh
authors.initials: G
authors.lastname: Tsuji
authors.affiliation: Department of Rheumatology, Shinko Hospital, Kobe, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Kumagai
authors.affiliation: Department of Rheumatology, Kobe University Hospital, Kobe, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Morinobu
keywords: And systemic rheumatic disease; FRAX; Fragility fracture; Glucocorticoid induced osteoporosis; High-dose glucocorticoid therapy