Li, Ling

Bensing, Sophie

Falhammar, Henrik

2021-04-12

PURPOSE: The association between glucocorticoid replacement therapy for adrenal insufficiency (AI) and osteoporosis is unclear. Fracture is a major cause of morbidity in patients with osteoporosis. This study aims to determine if patients on glucocorticoid replacement therapy for AI have an increased rate of fractures compared to the general population. METHODS: We included all studies with adult patients receiving glucocorticoid replacement therapy for either congenital adrenal hyperplasia (CAH), primary adrenal insufficiency (PAI), or secondary adrenal insufficiency (SAI). Studies without fracture data were excluded, as well as meeting abstracts. Studies with fractures but without a control group were eligible to be included in the systematic review but not in the meta-analysis. The primary outcome was the number of fractures, which was further differentiated into osteoporotic fractures. In addition, the glucocorticoid dose equivalents used were noted whenever possible. RESULTS: Seventeen studies were included in the systematic review. Seven were used in the meta-analysis of any fracture and six were used for osteoporotic fracture. The reported fracture rate ranged between no fracture to 60.8% in the patient group and no fracture to 43.8% in the control group. The odds ratio (OR) for any fracture was 2.71 (95%CI: 1.36-5.43, P = 0.005) and for osteoporotic fracture 2.76 (95%CI: 2.39-3.19 P < 0.00001), favoring the control group. CONCLUSIONS: Patients with AI on glucocorticoid replacement therapy have a higher rate of fractures compared to the control population.

Department of Endocrinology, Royal Darwin Hospital, Darwin, NT, Australia. ling.alice.li@gmail.com.

Department of Endocrinology, Gold Coast University Hospital, Southport, QLD, Australia. ling.alice.li@gmail.com.

Department of Endocrinology, Metabolism and Diabetes, Royal Brisbane and Women's Hospital, Herston, QLD, Australia. ling.alice.li@gmail.com.

Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.

Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Department of Endocrinology, Royal Darwin Hospital, Darwin, NT, Australia.

Menzies School of Health Research, Darwin, NT, Australia.

Endocrine . 2021 Oct;74(1):29-37. doi: 10.1007/s12020-021-02723-z. Epub 2021 Apr 12.

0000-0002-5412-6595

https://pubmed.ncbi.nlm.nih.gov/33846948/?otool=iaurydwlib

https://hdl.handle.net/10137/11749

Rate of fracture in patients with glucocorticoid replacement therapy: a systematic review and meta-analysis.

Journal Article

Publication