Steroids risky in the short-term


Short-term use of oral corticosteroids in the community is associated with an up to five-fold risk of fractures, blood clots and sepsis, new research shows.

In the study of over 1.5 million US adults 18-64 years the incidence rate ratio for any dose of corticosteroids compared to no corticosteroids was 1.87 for fracture, 3.33 for VTE and 5.30 for sepsis.

The patients typically received doses of 20mg a day for about six days for a range of indications including upper respiratory infections, spinal conditions, allergies and bronchitis.

“The 30 day risk of venous thromboembolism, fracture and hospital admission from sepsis was statistically significantly increased for patients presenting with both respiratory and musculoskeletal conditions,” the researchers said in their study published in The BMJ.

Rheumatologist and epidemiologist Professor Rachelle Buchbinder director of the Monash Department of Clinical Epidemiology said the findings highlighted the need for clinicians to consider whether the use of oral steroids for a particular problem is evidence-based.

“If known to be ineffective, they should not be used. If of unknown efficacy or safety, then we need to collect the data about the balance of benefits and harms,” she told the limbic.

“I think GPs and specialists are well aware of the potential harms of oral steroids and already do try to use lowest doses and encourage those on long-term steroids to reduce the dose to the lowest possible,” she said.

The researchers said their findings were consistent with pathophysiological evidence of early changes in the immune system and rapid alteration of markers in bone metabolism with oral corticosteroid use.

“The mechanisms underlying the increase in venous thromboembolism are not fully known. However, infection is a common trigger of thrombosis, suggesting that both venous thromboembolism and sepsis may be potentially mediated through changes in the immune system,” they said.

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