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Glucocorticoids predict 10-year fragility fracture risk in a population-based ambulatory cohort of men and women: Canadian Multicentre Osteoporosis Study (CaMos)

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Abstract

Summary

We determined the prospective 10-year association among incident fragility fractures and four glucocorticoid (GC) treatment groups (Never GC, Prior GC, Baseline GC, and Ever GC). Results showed that GC treatment is associated with increased 10-year incident fracture risk in ambulatory men and women across Canada.

Purpose

Using the Canadian Multicentre Osteoporosis Study dataset, we determined the prospective 10-year association between incident fragility fractures and GC treatment.

Methods

We conducted a 10-year prospective observational cohort study at nine sites across Canada. A total of 9,263 ambulatory men and women 25 years of age and older were included in the analysis. Multivariable Cox proportional hazards analyses were conducted to determine the relationship among GC treatment groups in four levels that included Never GC, Prior GC, Baseline GC, and Ever GC (combined baseline and prior groups) and time to fracture.

Results

In each of the Never GC, Prior GC, Baseline GC, and Ever GC treatment groups, the number of participants were 8,832 (95.4 %), 303 (3.3 %), 128 (1.4 %), and 431 (4.7 %), respectively. Of the 9,263 individuals enrolled, incident fragility non-spine, hip, spine, and any fractures were experienced by a total of 896 (9.67 %), 157 (1.69 %), 130 (1.40 %), and 1,102 (11.90 %) over 10-years, respectively. For men and women combined, prior GC treatment was associated with a higher hazard ratio (HR) for time to incident non-vertebral (HR = 1.5, 95 % confidence interval [CI] = 1.1, 2.0), hip (HR = 2.1, 95 % CI = 1.1, 4.0), and any fracture (HR = 1.4, 95 % CI = 1.0, 1.8) compared with never GC treatment.

Conclusions

GC treatment is associated with increased 10-year incident fracture risk; this highlights the importance of considering therapy to prevent GC-induced fractures for patients who are using GC for various medical conditions.

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Conflicts of interest

G. Ioannidis, S. Pallan, M. Mulgund, L. Rios, J. Ma, L. Thabane, K. S. Davison, C. S. Kovacs, N. Kreiger, J. C. Prior, and T. Towheed declare that they have no conflict of interest.

A. Papaioannou: Speaker's bureau: Amgen, Eli Lilly, Merck, Novartis, Procter & Gamble, Sanofi Aventis, Warner Chilcott. Research grants: Amgen, Eli Lilly, Merck, Novartis, Procter & Gamble, Sanofi Aventis, Warner Chilcott. Consulting fees or other remuneration (payment): Amgen, Eli Lilly, Merck, Novartis, Procter & Gamble, Roche, Sanofi Aventis, Warner Chilcott, Wyeth.

R. G. Josse: Advisory board member: Amgen, Lilly, Merck, Novartis, BMS/AZ, Janssen. Speaker honoraria: Amgen, Lilly, Merck, Novartis, BMS/AZ, Janssen. Research grants: Amgen, Janssen, BMS/AZ.

W. P. Olszynski: Consultant or on a speaker's bureau for Amgen, Eli Lilly, Merck Frosst Canada, Novartis, Pfizer, Procter & Gamble Pharmaceuticals and sanofi-aventis.

J. D. Adachi: Speaker's bureau: Amgen, Eli Lilly, Merck, Novartis, Procter & Gamble, Roche, Sanofi Aventis, Warner Chilcott. Research grants: Amgen, Bristol-Myers Squibb, Eli Lilly, Merck, Novartis, Pfizer, Procter & Gamble, Roche, Sanofi Aventis, Warner Chilcott, Wyeth. Consulting fees or other remuneration (payment): Amgen, Eli Lilly, GSK, Merck, Novartis, Pfizer, Procter & Gamble, Roche, Sanofi Aventis, Warner Chilcott, Wyeth.

Grant support

The Canadian Multicentre Osteoporosis Study was funded by the Canadian Institutes of Health Research (CIHR), Amgen, Merck Frosst Canada Ltd., Eli Lilly Canada Inc., Novartis Pharmaceuticals Inc., The Alliance: sanofi-aventis and Procter and Gamble Pharmaceuticals Canada Inc., The Dairy Farmers of Canada, and The Arthritis Society.

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Authors and Affiliations

  1. Faculty of Medicine, McMaster University, Hamilton, ON, Canada

    George Ioannidis, Alexandra Papaioannou & Jonathan D. Adachi

  2. Department of Medicine, McMaster University, Hamilton, ON, Canada

    Shelley Pallan

  3. Department of Rheumatology, McMaster University, Hamilton, ON, Canada

    Manisha Mulgund

  4. Medicina Interna, Hospital Clinico FUSAT, Rancagua, VI Region, Chile

    Lorena Rios

  5. Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada

    Jinhui Ma

  6. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Lehana Thabane

  7. University of Victoria, Victoria, BC, Canada

    Kenneth S. Davison

  8. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Robert G. Josse

  9. Faculty of Medicine- Endocrinology, Memorial University, St. John’s, Newfoundland and Labrador, Canada

    Christopher S. Kovacs

  10. Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Nancy Kreiger

  11. Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada

    Wojciech P. Olszynski

  12. Department of Medicine/Endocrinology, University of British Columbia, British Columbia, Canada

    Jerilynn C. Prior

  13. Department of Medicine, Queen’s University, Kingston, ON, Canada

    Tanveer Towheed

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  1. George Ioannidis
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  2. Shelley Pallan
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  15. Jonathan D. Adachi
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CaMos Research Group

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Correspondence to George Ioannidis.

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Ioannidis, G., Pallan, S., Papaioannou, A. et al. Glucocorticoids predict 10-year fragility fracture risk in a population-based ambulatory cohort of men and women: Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 9, 169 (2014). https://doi.org/10.1007/s11657-013-0169-5

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  • DOI: https://doi.org/10.1007/s11657-013-0169-5

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