Topical Steroids: Dose and Duration May Matter

Glucocorticoid-induced osteoporosis occurs in 30% of patients treated chronically with systemic corticosteroids (> 6 months) – and vertebral fractures are a common consequence. It’s thought that inhaled and topical formulations do not pose a similar osteoporosis risk. However, an analysis of over 700,000 adults treated with topical corticosteroids (TCS) over a 15-year time period suggests there may be a connection. Among the group, 56% were identified as having long-term exposure to potent or very potent TCS (defined by the cumulative number of filled prescriptions converted to equipotent doses of mometasone). The rate of osteoporosis diagnoses ranged from 43% (cumulative use equivalent to 500-999 gm of mometasone) to nearly 59% (cumulative use equivalent to greater than or equal to 10,000 gm of mometasone) compared to 37% in a low-exposure group (cumulative use equivalent less than 500 gm) per 10,000 person-years. The vertebral fracture rate was 15% in the highest TCS users compared with 10% in the lowexposure group.

This study does not indicate that long-term use of conventionl TCS (prescribed for most dermatology conditions) increases the risk of osetoporosis. However, it does suggest a cumulative dose-response relationship for potent and very potent TCS. The best approach, as usual, is choosing the lowest potency TCS that effectively treats a condition for the shortest duration possible.• Egeberg A. JAMA Dermatol 2021; doi:10.1001/ jamadermatol.2020.4968

Glucocorticoid-induced osteoporosis occurs in 30% of patients treated chronically with systemic corticosteroids (> 6 months) – and vertebral fractures are a common consequence. It’s thought that inhaled and topical formulations do not pose a similar osteoporosis risk. However, an analysis of over 700,000 adults treated with topical corticosteroids (TCS) over a 15-year time period suggests there may be a connection. Among the group, 56% were identified as having long-term exposure to potent or very potent TCS (defined by the cumulative number of filled prescriptions converted to equipotent doses of mometasone). The rate of osteoporosis diagnoses ranged from 43% (cumulative use equivalent to 500-999 gm of mometasone) to nearly 59% (cumulative use equivalent to greater than or equal to 10,000 gm of mometasone) compared to 37% in a low-exposure group (cumulative use equivalent less than 500 gm) per 10,000 person-years. The vertebral fracture rate was 15% in the highest TCS users compared with 10% in the lowexposure group.

This study does not indicate that long-term use of conventionl TCS (prescribed for most dermatology conditions) increases the risk of osetoporosis. However, it does suggest a cumulative dose-response relationship for potent and very potent TCS. The best approach, as usual, is choosing the lowest potency TCS that effectively treats a condition for the shortest duration possible.• Egeberg A. JAMA Dermatol 2021; doi:10.1001/ jamadermatol.2020.4968

Glucocorticoid-induced osteoporosis occurs in 30% of patients treated chronically with systemic corticosteroids (> 6 months) – and vertebral fractures are a common consequence. It’s thought that inhaled and topical formulations do not pose a similar osteoporosis risk. However, an analysis of over 700,000 adults treated with topical corticosteroids (TCS) over a 15-year time period suggests there may be a connection. Among the group, 56% were identified as having long-term exposure to potent or very potent TCS (defined by the cumulative number of filled prescriptions converted to equipotent doses of mometasone). The rate of osteoporosis diagnoses ranged from 43% (cumulative use equivalent to 500-999 gm of mometasone) to nearly 59% (cumulative use equivalent to greater than or equal to 10,000 gm of mometasone) compared to 37% in a low-exposure group (cumulative use equivalent less than 500 gm) per 10,000 person-years. The vertebral fracture rate was 15% in the highest TCS users compared with 10% in the lowexposure group.

This study does not indicate that long-term use of conventionl TCS (prescribed for most dermatology conditions) increases the risk of osetoporosis. However, it does suggest a cumulative dose-response relationship for potent and very potent TCS. The best approach, as usual, is choosing the lowest potency TCS that effectively treats a condition for the shortest duration possible.• Egeberg A. JAMA Dermatol 2021; doi:10.1001/ jamadermatol.2020.4968

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