SynthesisEndocrine2021
Rate of fracture in patients with glucocorticoid replacement therapy: a systematic review and meta-analysis.
Synthesis in Endocrine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 31 citations in OpenAlex.
- Glucocorticoid reduction after starting crinecerfont in pediatric patients with classic congenital adrenal hyperplasia: practical perspectives.The Journal of clinical endocrinology and metabolism · 2026Review
- Glucocorticoid reduction after starting crinecerfont in adult patients with classic CAH: practical perspectives.The Journal of clinical endocrinology and metabolism · 2026Article
- Angiotensin converting enzyme-2 activation mitigates glucocorticoids-induced osteoporosis in rats by modulating oxidative stress, inflammation and the RANKL/OPG pathway.Pflugers Archiv : European journal of physiology · 2026Article
- Sex differences in clinical and metabolic outcomes of glucocorticoid replacement therapy in adrenal insufficiency.Pituitary · 2026Review
- Fracture risks in patients aged 50 years and older with panhypopituitarism: a nationwide cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Review
- Increased risk of osteoporotic fractures and osteoporosis in patients with Addison's disease in Sweden: A nationwide population-based cohort study.Journal of internal medicine · 2025Article
- Hypopituitarism and bone disease: pathophysiology, diagnosis and treatment outcomes.Pituitary · 2024Review
- Predictors of bone mineral density in patients receiving glucocorticoid replacement for Addison's disease.Endocrine · 2024Article
- Increased Prevalence of Accidents and Injuries in Congenital Adrenal Hyperplasia: A Population-based Cohort Study.The Journal of clinical endocrinology and metabolism · 2024Article
- Bone mineral density determinants in adolescents and young adults with congenital adrenal hyperplasia.Frontiers in pediatrics · 2024Article
- Effects of Dual-Release Hydrocortisone on Bone Metabolism in Primary and Secondary Adrenal Insufficiency: A 6-Year Study.Journal of the Endocrine Society · 2023Article
- Interpretation of Steroid Biomarkers in 21-Hydroxylase Deficiency and Their Use in Disease Management.The Journal of clinical endocrinology and metabolism · 2023Review
- Bone Tissue Evaluation Indicates Abnormal Mineralization in Patients with Autoimmune Polyendocrine Syndrome Type I: Report on Three Cases.Calcified tissue international · 2023Article
- Bone safety of dual-release hydrocortisone in patients with autoimmune primary adrenal insufficiency.Frontiers in endocrinology · 2023Article
- Approach of Heterogeneous Spectrum Involving 3beta-Hydroxysteroid Dehydrogenase 2 Deficiency.Diagnostics (Basel, Switzerland) · 2022Review
- Long-term outcomes of conventional and novel steroid replacement therapy on bone health in primary adrenal insufficiency.Scientific reports · 2022Article
- Long-Term Outcomes of Congenital Adrenal Hyperplasia.Endocrinology and metabolism (Seoul, Korea) · 2022Review
- The Bone Strain Index: An Innovative Dual X-ray Absorptiometry Bone Strength Index and Its Helpfulness in Clinical Medicine.Journal of clinical medicine · 2022Review
- Increased Prevalence of Fractures in Congenital Adrenal Hyperplasia: A Swedish Population-based National Cohort Study.The Journal of clinical endocrinology and metabolism · 2022Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe association between glucocorticoid replacement therapy for adrenal insufficiency (AI) and osteoporosis is unclear. Fracture is a major cause of morbidity in patients with osteoporosis. This study aims to determine if patients on glucocorticoid replacement therapy for AI have an increased rate of fractures compared to the general population.
methodsWe included all studies with adult patients receiving glucocorticoid replacement therapy for either congenital adrenal hyperplasia (CAH), primary adrenal insufficiency (PAI), or secondary adrenal insufficiency (SAI). Studies without fracture data were excluded, as well as meeting abstracts. Studies with fractures but without a control group were eligible to be included in the systematic review but not in the meta-analysis. The primary outcome was the number of fractures, which was further differentiated into osteoporotic fractures. In addition, the glucocorticoid dose equivalents used were noted whenever possible.
resultsSeventeen studies were included in the systematic review. Seven were used in the meta-analysis of any fracture and six were used for osteoporotic fracture. The reported fracture rate ranged between no fracture to 60.8% in the patient group and no fracture to 43.8% in the control group. The odds ratio (OR) for any fracture was 2.71 (95%CI: 1.36-5.43, P = 0.005) and for osteoporotic fracture 2.76 (95%CI: 2.39-3.19 P < 0.00001), favoring the control group.
conclusionsPatients with AI on glucocorticoid replacement therapy have a higher rate of fractures compared to the control population.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.