Osteoporosis, a condition characterized by reduced bone density and an increased risk of fractures, is linked to systemic corticosteroid use (usually in the form of oral pills or tablets.) However, a recent comprehensive study published in the Journal of the European Academy of Dermatology and Venereology has sought to delve into the nuanced relationship between topical corticosteroids (usually in the form of creams, lotions, ointments, etc) and osteoporosis.
In their analysis, the researchers converted cumulative topical corticosteroid (TCS) doses to prednisolone equivalents and considered factors such as age, sex, comorbidities, and medications in their adjustments. The findings revealed clear dose-response relationships between TCS exposure and both osteoporosis and major osteoporotic fracture (MOF), particularly in extended periods of TCS use.
Female patients exhibited higher odds ratios (ORs) than males for both osteoporosis and MOF. This finding aligns with the known increased risk of osteoporosis in postmenopausal women due to the inherent estrogen deficiency that comes with menopause. Surprisingly, younger individuals (below 50 years) exposed to high cumulative TCS doses demonstrated the highest OR for osteoporosis, highlighting a potential vulnerability in this age group.
The study also revealed that current TCS users had an increased risk of osteoporosis compared to past users, although this phenomenon was not as pronounced in MOF analysis. This suggests that the current usage of TCS might be a more substantial factor in the occurrence of osteoporosis than MOF.
Miscoding and misclassification inherent in database research, potential inaccuracies in TCS prescription data representing actual usage, and the inability to assess some confounding factors, such as smoking and physical activity, were acknowledged as potential limitations.
This in-depth study provides valuable insights into the complex relationship between TCS use and osteoporosis. The findings emphasize the importance of exercising caution, especially with high cumulative doses of TCS, and highlight the need for monitoring vulnerable populations, such as postmenopausal women and younger individuals. As TCS are widely used for the treatment of various inflammatory skin conditions, the study encourages clinicians to be mindful of the potential impact on bone health, prompting consideration of alternative dermatological treatments in certain patient populations.
