Medical Technology

Do Oral Corticosteroids Drive Fracture Risk in Atopic Eczema?

NEW YORK (Reuters Health) – Oral corticosteroids do not appear to be an important driver of major osteoporotic fractures in adults with atopic eczema, according to a large cohort study from the United Kingdom.

“Evidence suggests adults with atopic eczema have increased fracture risk. However, it is unclear whether oral corticosteroids explain the association,” first author Julian Matthewman of London School of Hygiene and Tropical Medicine and colleagues note in the Journal of Allergy and Clinical Immunology: In Practice.

To investigate, the study team identified more than 526,000 adults with atopic eczema using primary care and hospital admission records and matched them with 2.6 million adults without atopic eczema.

Adults with and without atopic eczema were “broadly” similar in terms of age, gender, body mass index, smoking and indices of multiple deprivation. Those with atopic eczema were more likely to have asthma (28% vs. 15%) and at least one prescription for oral corticosteroids (28% vs. 14%).

The team found an association between atopic eczema and major osteoporotic fractures of the spine (HR, 1.15; 99% confidence interval, 1.08 to 1.22) and hip (HR, 1.11; 99% CI, 1.08 to 1.15) that persisted after adjusting for oral corticosteroid use (spine HR, 1.09; 99% CI, 1.03 to 1.16, and hip HR, 1.09; 99% CI, 1.06 to 1.12).

Fracture rates were higher in adults with severe atopic eczema compared with those without, even after adjusting for oral corticosteroid use, they report.

“In line with current atopic eczema management guidelines, which reserve the use of oral corticosteroids for exceptional circumstances, clinicians should continue to avoid oral corticosteroids for atopic eczema,” the authors say.

They note that current guidelines recommend screening for fracture risk in adults taking oral corticosteroids but do not specifically reference atopic eczema.

“Our results indicate that atopic eczema, especially severe atopic eczema, should be considered for inclusion in fracture-risk screening guidelines. Further research should explore why there is a link between atopic eczema and fracture, including the role of topical corticosteroids,” they write.

SOURCE: Journal of Allergy and Clinical Immunology: In Practice, online September 24, 2021

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