Paradoxically protective effect of glucocorticoids on bone mass and fragility fracture in a large cohort: a cross sectional study

Abstract

Abstract Objectives Glucocorticoids (GC) increase risk of fracture through reduction in bone mineral density (BMD); they may also reduce bone quality, but recent supporting data are scarce. We aimed to confirm these effects in a large population-based cohort. Methods We used data from patients referred for first hip and lumbar spine BMD estimation by the sole Dual X-Ray absorptiometry (DEXA) in the North West of England between June 2004 and September 2016. We compared history of fractures and BMD between patients currently on GC and patients never exposed to GC. A logistic model adjusted for possible confounders. Results Over 20,000 subjects were included, mean age 63 (SD 13) years, 82% female; 19% currently on GC. GC patients were more often male, with higher BMI, but their age was similar to those not exposed to GC. Surprisingly GC patients had about 2% higher BMD at both sites (p < 0.001) and lower prevalence of (history of) fractures (22% vs 34%; p < 0.001). The corresponding odds ratio was 0.53 (95%CI 0.49,0.58); adjustment for age, gender, body mass index and number of indications for scanning did not alter the association. Conclusion In this large population-based cohort current GC use compared with never use was associated with higher bone mass and less rather than more fractures after adjusting for confounders. These results may be subject to unmeasured confounding, but for now they do not lend support to a detrimental bone effect of GC.