Osteonecrosis following short-term, low-dose oral corticosteroids: a population-based study of 24 million patients.

Abstract

Although the association between chronic, high-dose corticosteroid use and osteonecrosis is well known, the incidence of osteonecrosis following short-term, low-dose steroid taper packs has never been reported across a large population. The goal of this study was to report the incidence and risk of osteonecrosis after methylprednisolone taper pack (MTP) prescriptions in a multicenter electronic medical records database. A commercially available software platform was used to evaluate the records of 24,533,880 patients to determine the incidence of osteonecrosis in patients who had received single or multiple MTP over a 12-year period. This was compared with the incidence of osteonecrosis in patients who had never been prescribed an MTP. Patients with a history of osteonecrosis or prior corticosteroid use were excluded from the study. A total of 98,390 patients were identified who had received a single MTP. One hundred thirty (0.132%; 95% confidence interval [CI], 0.176%-0.283%) of these patients were subsequently diagnosed with osteonecrosis. The incidence of osteonecrosis in patients who had been prescribed 2 or more MTPs was 0.230% (95% CI, 0.176%-0.283%). Compared with the 0.083% incidence of osteonecrosis in the control group that had never been prescribed an MTP, the relative risk of osteonecrosis after the prescription of a single MTP or multiple MTPs was 1.591 and 2.763, respectively, with a statistically significant difference between cohorts (P<.001). Short-term, low-dose oral corticosteroid administration may be associated with a low but statistically significant increased incidence of osteonecrosis when compared with patients who have never been prescribed a steroid product.

• Authors: Matthew F Dilisio
• Journal: Orthopedics (Orthopedics) Vol. 37 Issue 7 Pg. e631-6 (Jul 2014) ISSN: 1938-2367 [Electronic] United States
• PMID: 24992058 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright 2014, SLACK Incorporated.

Chemical References

• Glucocorticoids
• Methylprednisolone

Topics

• Administration, Oral
• Databases, Factual
• Electronic Health Records
• Female
• Glucocorticoids (administration & dosage, adverse effects)
• Humans
• Male
• Methylprednisolone (administration & dosage, adverse effects)
• Osteonecrosis (chemically induced, epidemiology)
• Software
• United States (epidemiology)