Low-dose corticosteroids and avascular necrosis of the hip and knee

✍ Scribed by Mark Bauer; Paulette Thabault; Dan Estok; Cindy Christiansen; Richard Platt

• Book ID: 101354504
• Publisher: John Wiley and Sons
• Year: 2000
• Tongue: English
• Weight: 57 KB
• Volume: 9
• Category: Article
• ISSN: 1053-8569
• DOI: 10.1002/1099-1557(200005/06)9:3<187::aid-pds494>3.0.co;2-j

✦ Synopsis

Background:

Although high-dose corticosteroid use constitutes a well-known risk factor for avascular necrosis (avn), the risk of avn with low-dose corticosteroids is not well established.

Objective:

To assess avn risk for high-dose and low-dose oral corticosteroid exposure compared to baseline risk.

Methods:

We employed a nested case-control study design. avn of the hip and knee was determined from coded diagnoses and full text record review. corticosteroid exposure was ascertained through outpatient automated pharmacy dispensing files.

Results:

Thirty-one cases occurred during approximately 720,000 person years. eleven of 22 cases that met all eligibility criteria received oral corticosteroids during the 3 years before diagnosis. there was a cumulative dose-related corticosteroid effect from no excess risk (relative risk=0.95% confidence interval=0-5) for doses 1-430 mg, to a relative risk of 6 (95% ci 1-43) for doses of 440-1290 mg, and an undefined relative risk (95% lower ci 26) for doses greater than 1290 mg.

Conclusions:

Systemic corticosteroids were strongly associated with avn, however, the effect was not clearly evident at 3-year cumulative doses