ArticleBMJ open2017
Oral glucocorticoid use and osteonecrosis in children and adults with chronic inflammatory diseases: a population-based cohort study.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 44 citations in OpenAlex.
- Corticosteroid-associated osteonecrosis in paediatric compared with adult patients: are they the same disease?Bone & joint open · 2026Article
- Pathogenesis and molecular mechanisms of steroid-induced femoral head necrosis in children: a narrative review.Frontiers in pediatrics · 2026Review
- Risk Factors for Corticosteroid-associated Osteonecrosis in Children: A National Database Study.Journal of the Pediatric Orthopaedic Society of North America · 2025Article
- Efficacy and safety of bisphosphonates in pediatric glucocorticoid-induced osteoporosis: a meta-analysis and pharmacovigilance study.Frontiers in pediatrics · 2025Article
- Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: The Results from a Retrospective Cohort Tertial Center Study.Life (Basel, Switzerland) · 2023Article
- Article
- High risk of depression, anxiety, and an unfavorable complex comorbidity profile is associated with SLE: a nationwide patient-level study.Arthritis research & therapy · 2022Article
- Glucocorticoid induced adrenal insufficiency in children: Morning cortisol values to avoid LDSST.Frontiers in pediatrics · 2022Article
- MRI Findings in Hip in Juvenile Idiopathic Arthritis.Journal of clinical medicine · 2021Article
- Spontaneous bone infarction of the distal femur in a patient with Cushing's disease: a case report.Bone reports · 2021Article
- Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children.American journal of epidemiology · 2021Article
- Hip Involvement in Juvenile Idiopathic Arthritis: A Roadmap From Arthritis to Total Hip Arthroplasty or How Can We Prevent Hip Damage?Frontiers in pediatrics · 2021Article
- Risk of peri-operative complications in children receiving preoperative steroids.Pediatric surgery international · 2020Article
- Medium-term outcomes of total hip arthroplasty in juvenile patients.Journal of orthopaedic surgery and research · 2020Article
- Association of Diabetes Mellitus and Biomarkers of Abnormal Glucose Metabolism With Incident Radiographic Knee Osteoarthritis.Arthritis care & research · 2020Article
- Glucocorticoid-induced osteoporosis: 2019 concise clinical review.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Review
- Clinical characteristics of avascular necrosis in patients with Behçet disease: a case series and literature review.Rheumatology international · 2019Review
- Glucocorticoid treatment in juvenile idiopathic arthritis.Rheumatology international · 2019Review
Corrections and comments
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Authors and funding
8 authors at 6 institutions in 1 country.
Funding
Abstract
objectivesWe studied oral glucocorticoids and osteonecrosis, a rare but serious bone disease, in individuals with various chronic inflammatory diseases. We hypothesised that we would find stronger associations in adults versus children and in people with autoimmune diseases.
designRetrospective cohort study.
settingPopulation-representative data (1994-2013) from general practices in the UK.
participantsChildren and adults diagnosed with asthma; inflammatory bowel disease; juvenile, psoriatic or rheumatoid arthritis; psoriasis; or systemic lupus. EXPOSURES: Oral glucocorticoid patterns. PRIMARY AND SECONDARY OUTCOME MEASURES: Diagnosed osteonecrosis (primary) and osteonecrosis plus clinical features (eg, symptoms, pain medication, surgical repair) (secondary). Discrete time failure models estimated the adjusted hazard ratio (aHR) of incident osteonecrosis following oral glucocorticoid exposure. Hypothesis testing was one sided (with corresponding 90% CI) since glucocorticoids were unlikely protective.
resultsAfter adjusting for demographic, disease-related and health utilisation factors, glucocorticoid exposure was associated with osteonecrosis in adults (ages 18-49, aHR 2.1 (90% CI 1.5 to 2.9); ages ≥50, aHR 1.3 (90% CI 1.01 to 1.7)). However, low-dose glucocorticoids, corresponding to average doses <7.5 mg prednisolone daily and maximum doses <30 mg daily, were not associated with osteonecrosis in adults. Furthermore, even at high glucocorticoid doses, there was no evidence of increased osteonecrosis among glucocorticoid-exposed children (p=0.04 for interaction by age) (any glucocorticoid exposure, ages 2-9: aHR 1.1 (90% CI 0.7 to 1.7); ages 10-17: aHR 0.6 (90% CI 0.3 to 1.6)). Arthritis, inflammatory bowel disease and lupus were independently associated with osteonecrosis, but there was a similar dose relationship between glucocorticoids and osteonecrosis among adults with low-risk and high-risk diseases.
conclusionsGlucocorticoid use was clearly associated with osteonecrosis in a dose-related fashion in adults, especially young adults, but this risk was not detectable in children. The absolute risk of glucocorticoid-associated osteonecrosis in the general paediatric population and in adults taking low glucocorticoid doses is at most extremely small.
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