A simple score for estimating the long-term risk of fracture in patients using oral glucocorticoids
From the 1Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands, 2MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK, 3Procter & Gamble Pharmaceuticals, Egham, UK, 4Department of Rheumatology, University Hospital, Maastricht, Netherlands, 5Limburg University Center, Diepenbeek, Belgium, and 6Erasmus University Medical Center, Rotterdam, Netherlands
Received 29 September 2004 and in revised form 12 January 2005
Background: Previous analyses of risk factors for glucocorticoid (GC)-induced osteoporosis have focused on the estimation of relative rather than absolute fracture probability.
Aim: To estimate risk scores for the individual probability of fracture in GC users.
Design: Retrospective data analysis.
Methods: We evaluated all patients aged 40 years or older with a prescription for oral GCs in the General Practice Research Database (GPRD), which comprises the computerized medical records of around 7 million UK subjects. Individual risk factors for osteoporotic fractures were identified, and combined in a predictive model for 10-year absolute fracture risk.
Results: Of 191 752 oral GC users aged 
40 years, 7412 experienced an osteoporotic fracture. Several characteristics independently contributed to the fracture risk score (GC therapy, age, gender, fall history, fracture history, body mass index, smoking, previous diagnoses, use of medication, recent hospitalization and indication for GC treatment). Scores of 30, 40 and 50 corresponded to absolute 5-year fracture risks of 6.2%, 15.3% and 35.2%, respectively. A woman aged 65 years with RA, low BMI, and a previous history of fracture and falls, who used 15 mg GC daily (total risk score 54) would have a 5-year fracture risk of 47% (a man with similar history, 30.1%). Short-term use of high-dose GC therapy (30 mg) was associated with only a small increased risk of osteoporotic fracture (RR 1.21, 95%CI 1.04–1.42) in patients with a history of GC use.
Discussion: This risk score helps to predict an individual's risk of fracture during GC use. Decisions about bone protection treatment could be based on long-term risks of fracture.
Address correspondence to Professor C. Cooper, MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton SO16 6YD. e-mail: cc{at}mrc.soton.ac.uk
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