Hellerup, Denmark—While it is well understood that systemic and inhaled corticosteroids can affect bone remodeling and trigger osteoporosis and bone fracture when given continuously or in high doses, not as much information is available on how topical corticosteroids affect the risk of osteoporosis and major osteoporotic fracture (MOF).

A study published in JAMA Dermatology focused on the adverse effects of topical corticosteroids (TCSs), examining the association between cumulative exposure to potent and very potent TCSs and risk of osteoporosis and MOF.

“Use of potent or very potent TCSs was independently associated with increased risk of osteoporosis and MOF,” Danish researchers report. “Use of these drugs is very common, and we found an estimated population attributable risk of as much as 4.3%.”

The authors add, however, that the absolute risk for the individual average user of TCSs remains low, explaining, “For people requiring potent treatment on large body surfaces for prolonged periods, other corticosteroid-sparing treatments for inflammatory dermatoses may be considered, although the benefit of such intervention, strictly speaking, has not been demonstrated for TCS users. Alternatively, earlier evaluation of and prophylaxis for osteoporosis and prophylactic therapy may be considered in patients with extensive use of potent and very potent TCS.”

The nationwide retrospective cohort study included 723,251 Danish adults treated with potent or very potent TCSs from January 1, 2003, to December 31, 2017. Data, which were obtained from Danish nationwide registries, were analyzed from June 1 to August 31, 2019.

Included in the analysis were 723,251 adults treated with the equivalent of at least 200 g of mometasone—52.8% women; mean [SD] age, 52.8 [19.2] years. Patients were considered exposed when they had filled prescriptions of cumulative amounts corresponding to the equivalent of at least 500 g of mometasone, using filled prescriptions of 200 to 499 g as the reference group. Defined as the coprimary outcomes were a diagnosis of osteoporosis or MOF.

According to the results, dose-response associations were found between increased use of potent or very potent TCSs and the risk of osteoporosis and MOF.

Researchers provided these examples of hazard ratios (HRs) of MOF:
• 1.01(95% CI, 0.99-1.03) for exposure to 500 to 999 g
• 1.05 (95% CI, 1.02-1.08) for exposure to 1,000 to 1,999 g
• 1.10 (95% CI, 1.07-1.13) for exposure to 2,000 to 9,999 g
• 1.27 (95% CI, 1.19-1.35) for exposure to at least 10,000 g

The study also described how a 3% relative risk increase of osteoporosis and MOF was observed per doubling of the cumulative TCS dose (HR, 1.03 [95% CI, 1.02-1.04] for both). Overall, the authors calculate the population-attributable risk at 4.3% (95% CI, 2.7%-5.8%) for osteoporosis and 2.7% (95% CI, 1.7%-3.8%) for MOF.

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