Parenteral Corticosteroids After Fragility Fracture Increases the Odds of a Repeat Fracture

Purpose To determine if corticosteroid use is associated with repeat fragility fractures and the trends in corticosteroid usage in this population. Methods 2,643 patients with repeat fractures were identified in the Research Action for Health Network (REACHnet). Each patient had a non-traumatic fracture diagnosis code with at least one year of medical history prior to the fracture and at least two years of follow-up time. Multivariable logistic regression was used to identify corticosteroid trends over time, predictors of a repeat fracture, and the effect of timing and type of corticosteroid on repeat fracture. Results Corticosteroid use was associated with a significantly increased risk of a second fragility fracture (Adjusted Odds Ratio, aOR = 1.39, 95% CI = 1.13-1.71). Parenteral corticosteroids were associated with significantly increased odds of re-fracture (aOR = 1.37. 95% CI = 1.08-1.74). Corticosteroid usage after initial fracture showed significantly increased odds of repeat fracture (aOR = 1.52, 95% CI = 1.20-1.91). Parenteral corticosteroid use after fracture was associated with an increased risk of re-fracture (aOR = 1.52, 95% CI 1.18-1.96).  Increased total dosage of steroids was not associated with an increase in the rate of repeat fractures. Conclusions Parenteral corticosteroid administration, especially if used after the initial fracture, was most likely to be associated with a repeat fracture. If steroids are indicated, the dosage may not alter repeat fracture risk. The method of administration or the timing may play a larger role, especially parenteral steroids after fracture. Physicians should weigh benefits and risk with parenteral corticosteroid use in fragility fracture patients.