Dilisio MF. Orthopedics. 2014. doi:10.3928/01477447-20140626-54.
A low but statistically significant link was determined between osteonecrosis and short-term, low-dose oral corticosteroids, according to study findings.
Researchers utilized a software platform to evaluate data from 24,533,880 patients who received either single or multiple methylprednisolone taper pack (MTP) prescriptions during a 12-year span. They then compared the incidence of osteonecrosis in patients who received MTP prescriptions with those who were never prescribed a MTP.
Of the 98,390 patients who received a single MTP, 130 were diagnosed with osteonecrosis, for an incidence rate of 0.132%. Patients who had received two or more MTPs had an incidence rate of 0.230%.
Compared with healthy controls, who had an osteonecrosis incidence rate of 0.083%, patients prescribed a single MTP had a relative risk of 1.591 for developing osteonecrosis, whereas patients prescribed two or more MTPs had a relative risk of 2.763. The between-group difference was statistically significant, according to the researchers.
Women prescribed multiple MTPs who had no prior osteonecrosis diagnoses or steroid use had the highest incidence of osteonecrosis (0.247%; relative risk: 3.094) when compared with sex-matched healthy controls.
Osteonecrosis Following Short-term, Low-dose Oral Corticosteroids: A Population-based Study of 24 Million Patients
Matthew F. Dilisio, MD
Orthopedics
July 2014 – Volume 37 · Issue 7: e631-e636
DOI: 10.3928/01477447-20140626-54
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.
The author is from the Department of Orthopaedic Surgery, Summa Health System, Akron, Ohio; and the Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts.
The author has no relevant financial relationships to disclose.
Correspondence should be addressed to: Matthew F. Dilisio, MD, Department of Orthopaedic Surgery, Summa Health System, 444 N Main St, Akron, OH 44310 ( dilisiom@gmail.com).