A high cumulative dose of topical corticosteroid from long-term use may increase risk of osteoporosis and bone fracture, according to a recent study in Taiwan.
While this risk has long been connected to systemic corticosteroid use, research into topical corticosteroids and bone damage has been inconclusive, the study authors claim, and information on corticosteroids’ effects on different sexes, ages and ethnic groups has also been lacking.
The research recently appeared in the Journal of the European Academy of Dermatology & Venereology.
Using data from the Taiwan National Health Insurance Research Database from 2002 to 2020, the researchers looked at 129,682 patients with osteoporosis and 34,999 patients with major osteoporotic fracture (MOF) and matched them with 518,728 and 139,996 population controls, respectively.
They found “clear dose–response relationships” between cumulative topical corticosteroid dose, osteoporosis, and MOF, “particularly for extended periods of [topical corticosteroid] exposure.”
Specifically, compared to those who did not use topical corticosteroids, adjusted odds ratios (ORs) of osteoporosis among topical corticosteroid users were 1.216, 1.260, and 1.341 for exposure to low, medium and high cumulative doses of corticosteroids, respectively, over 5 years.
Adjusted ORs of MOF among topical corticosteroid users were 1.118, 1.191, and 1.288 for exposure to low, medium and high cumulative doses, respectively, over 5 years.
Women had a higher risk of both osteoporosis and MOF, “indicating that women are more susceptible to the adverse effects of TCSs on bone.” The researchers were surprised to find that younger people (<50 years) exposed to high-dose topical corticosteroids had the highest risk of osteoporosis.
Both the patients with osteoporosis and the patients with MOF had more comorbidities and used more oral, injectable, or inhaled corticosteroids and medications that might affect bone health than did those in the control groups, the researchers noted.
The study methodology “did not yield a precise cutoff value that could unequivocally define a ‘high dose’ of topical corticosteroids associated with the most discernible risk” of bone damage, the researchers noted, but they concluded that because a higher cumulative topical corticosteroid dose was associated with increased risk of osteoporosis and MOF, “long-term [users] of [topical corticosteroids] should be cautious, especially in susceptible populations such as women and young people.”
Hsieh BJ, Shen D, Chan TC, Cho YT, Tang CH, Chu CY. Higher cumulative dose of topical corticosteroids is associated with osteoporosis and major osteoporotic fracture: A nationwide case-control study. J Eur Acad Dermatol Venereol. Published online December 20, 2023. doi:10.1111/jdv.19697