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Chiropractic Research Review

Corticosteroid Use May Increase Vertebral Fracture Risk

Many elderly patients take corticosteroids to treat chronic inflammatory and immune disorders. Corticosteroid use is thought to increase the risk of osteoporotic fractures by accelerating bone loss in regions of the skeleton with high trabecular bone content, including the spine.

However, the influence of duration of use on fracture risk remains unclear, as does the specific role other risk factors play, including bone mineral density (BMD) and age.

In this study, researchers studied 229 patients who had taken corticosteroids for at least six months' duration. An additional 286 patients with no reported use of corticosteroids were also recruited as controls. Thoracolumbar x-ray films, BMD, and details on duration of corticosteroid use were obtained from all patients, with results presented as follows:

* Sixty-five patients (28%) had at least one vertebral deformity; 25 (11%) had two or more deformities.

* Older age (independent of BMD) proved a significant risk factor for deformity; patients 70-79 years old had five times the risk compared with patients 60 years and younger.

image - Copyright – Stock Photo / Register Mark * Average lumbar spine and femoral neck BMD were lower in corticosteroid patients with deformities than nonusers with deformities.

* These effects were maintained when adjusting for the effects of age, sex, body mass index, and duration of corticosteroid use.

Conclusion: The combination of increasing age and corticosteroid use is associated with a substantial increase in the risk of vertebral deformities. The authors suggest that elderly patients consider these results when beginning long-term steroid therapy, and also recommend anti-osteoporosis measures be taken.

Note: Chiropractors should consider this information when providing care to this specific patient group.

Naganathan V, Jones G, Nash P, et al. Vertebral fracture risk with long-term corticosteroid therapy. Prevalence and relation to age, bone density, and corticosteroid use. Archives of Internal Medicine, Oct. 23, 2000:160, pp2917-22.

Chiropractic Research Review

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