Topical Corticosteroids May Weaken Bones, Researchers Warn

The findings of a new study suggest the side effects of topical corticosteroids may increase the risk of osteoporosis and bone fractures, especially at higher doses.

In a report published this week in the medical journal JAMA Dermatology, Danish researchers indicate there was a dose-response relationship between topical corticosteroids and problems with a weakening of the bones associated with osteoporosis, as well as bone fractures. Such findings tend to indicate a strong causal connection.

Researchers studied 723,000 Danish users of potent or very potent topical corticosteroids from 2003 to 2017. These types of drugs are commonly used to treat chronic skin conditions like atopic dermatitis and psoriasis.

The data was taken from Danish nationwide registries of filled prescription data for mometasone furcate, sold under the brand names Elocon, Nasonex and Asmanex, or similar types of powerful topical steroids like betamethasone validate or clobetasol propionate. The data focused on patients who filled prescriptions for cumulative amounts of topical steroids of at least 500 grams and compared that to patients who filled prescriptions of 200g to 499g.

The findings link the use of high doses of topical steroids to increased risk of osteoporosis and major osteoporotic fracture with a dose response association for cumulative use. The higher the dose or the more a patient used the steroid, the higher their risk.

Patients faced a 3% increased risk of osteoporosis and a 3% increased risk of major osteoporotic fracture for each doubling of the dose. Major osteoporotic fracture included fractures of the hip, distal antebrachium, vertebrae, or humerus.

Exposure to potent topical steroids accounted for 4% of the population’s overall risk for osteoporosis and 3% of the overall risk for major osteoporotic fracture.

For major osteoporotic fractures, doses of 1,000g or higher were linked with significantly increased risk of major fracture. The highest risk of both fractures and osteoporosis was seen at doses beyond 10,000g.

Prior research has shown systemic and inhaled corticosteroids negatively affect bone remodeling and cause osteoporosis and bone fracture when given continuously or in high doses. The new research adds to the body of evidence that any type of corticosteroid, inhaled or topical, negatively impacts bone health and increases the risk of osteoporosis.

Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis. Roughly 30% of all patients treated with systemic glucocorticoids for more than six months will develop glucocorticoid-induced osteoporosis.

While the data indicates increased risk for potent topical corticosteroids, it does not indicate that topical steroids used at conventional doses increase the risk. It is more common for conventional doses to be given by doctors than potent or very potent doses. However, the researchers indicated their findings highlight the need for further research into other treatments, and warn the use of potent topical steroids should be stopped before reaching cumulative dose thresholds.