Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/35991
Title: The use of oral glucocorticoids and the risk of major osteoporotic fracture in patients with myasthenia gravis
Authors: Safipour, Z
van Der Zanden, R
VAN DEN BERGH, Joop 
Janssen, P
Vestergaard, P
de Vries, F.
Driessen, JHM
Issue Date: 2022
Publisher: SPRINGER LONDON LTD
Source: OSTEOPOROSIS INTERNATIONAL, 33(3), p. 649-658
Abstract: Oral glucocorticoids may increase major osteoporotic fracture risk (MOF) in myasthenia gravis patients. To assess this risk, we performed a case-control study including all Danish patients with a MOF between 1995 and 2011. We also pooled our data with data from another study. We found no increased risk. Osteoporosis prevention remains advisable. Purpose/introduction The prolonged use of high doses of oral glucocorticoids (GCs), a common treatment in patients with myasthenia gravis (MG), may increase major osteoporotic fracture (MOF) risk. Previous epidemiological studies did not exclusively focus on patients with MG or had relatively few GC-exposed MG patients. Aims were to evaluate the risk of MOF in MG patients using oral GCs in a large study population and to perform a pooled analysis with data from previous work. Methods A population-based case-control study (1995-2011) was conducted using the Danish National Health Service. Cases had sustained a MOF, and controls had not. All were aged >= 18 years. Multivariate conditional logistic regression estimated odds ratios (ORs) among MG patients using oral GCs versus non-users. Adjustments were made for comorbidities and comedications. In the pooled analysis, results were pooled by the use of generic inverse variance methods, assuming a random-effects model. Results We identified 376,858 cases and 376,858 controls. MOF risk was not elevated in MG patients currently using oral GCs compared to MG patients not on oral GCs (ORadj.: 1.26 (95% CI 0.68-2.33)). The use of the highest cumulative dose of oral GCs (>= 7 g) did not show an increased risk of MOF among MG patients (ORadj.: 2.00 (95% CI 0.90-4.44)). Our pooled analysis also showed no association between oral GC use and MOF risk. Conclusion This study showed that oral GC use in patients with MG was not associated with increased risk of MOF in our case-control study and pooled analysis. Osteoporosis prevention in MG patients based on clinical guidelines remains advisable.
Notes: Driessen, JHM (corresponding author), Maastricht Univ, Dept Clin Pharm, Med Ctr, Maastricht, Netherlands.; Driessen, JHM (corresponding author), Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands.; Driessen, JHM (corresponding author), Cardiovasc Res Inst Maastricht CARIM, Maastricht, Netherlands.; Driessen, JHM (corresponding author), Maastricht Univ, NUTRIM Sch Nutr & Translat Res Metab, Maastricht, Netherlands.
annemariek.driessen@mumc.nl
Keywords: Glucocorticoids; Fracture; Bone; Myasthenia gravis; Case-control study
Document URI: http://hdl.handle.net/1942/35991
ISSN: 0937-941X
e-ISSN: 1433-2965
DOI: 10.1007/s00198-021-06101-3
ISI #: 000702791000001
Rights: Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License,
Category: A1
Type: Journal Contribution
Validations: ecoom 2022
Appears in Collections:Research publications

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