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1/
Enjoyed reading this rigorous #RxEpi study looking at a very important clinical topic for #dermtwitter - risk of #osteoporosis and # associated with potent topical steroids.
Follow this thread for a breakdown... https://twitter.com/JAMADerm/status/1351937549057601538
Enjoyed reading this rigorous #RxEpi study looking at a very important clinical topic for #dermtwitter - risk of #osteoporosis and # associated with potent topical steroids.
Follow this thread for a breakdown... https://twitter.com/JAMADerm/status/1351937549057601538
2/
The authors used the Danish national patient registry, which is a complete record of everyone in the country.
People using potent topical steroids were placed in different categories of cumulative use, all the way up to 10,000g (that's 100x 100g tubes of Mometasone!!)
The authors used the Danish national patient registry, which is a complete record of everyone in the country.
People using potent topical steroids were placed in different categories of cumulative use, all the way up to 10,000g (that's 100x 100g tubes of Mometasone!!)
3/
They calculated incidence rates (number of events / total follow-up time) and also adjusted for confounders in a model.
Headline finding: there was a dose-response relationship between topical steroids and #osteoporosis -quite convincing evidence for a causal relationship.
They calculated incidence rates (number of events / total follow-up time) and also adjusted for confounders in a model.
Headline finding: there was a dose-response relationship between topical steroids and #osteoporosis -quite convincing evidence for a causal relationship.
4/
Some great things the authors did increase confidence in the study:
1. use of negative control - an outcome not expected to be associated with the exposure. If there is an association, this indicates bias may be responsible for the findings. Here they chose hernia surgery.
Some great things the authors did increase confidence in the study:
1. use of negative control - an outcome not expected to be associated with the exposure. If there is an association, this indicates bias may be responsible for the findings. Here they chose hernia surgery.
5/
2. Because they could not measure some potentially important confounders, like smoking, they quantified unmeasured confounding and found that it would have to be very strong to invalidate the results.
3. They did tons of sensitivity analyses, all giving similar answers
2. Because they could not measure some potentially important confounders, like smoking, they quantified unmeasured confounding and found that it would have to be very strong to invalidate the results.
3. They did tons of sensitivity analyses, all giving similar answers
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I did find some things interesting though:
1. the fracture incidence was a lot higher than even osteoporosis! this may be because many people don't even know they have osteoporosis until the fracture, but does raise possibility of misclassification of osteoporosis
I did find some things interesting though:
1. the fracture incidence was a lot higher than even osteoporosis! this may be because many people don't even know they have osteoporosis until the fracture, but does raise possibility of misclassification of osteoporosis
7/
2. they could not take into account of dosage used of systemic steroids - this was more frequently used in the high topical steroid group, and all effects for osteoporosis were attenuated when people were censored at first systemic steroid treatment.
2. they could not take into account of dosage used of systemic steroids - this was more frequently used in the high topical steroid group, and all effects for osteoporosis were attenuated when people were censored at first systemic steroid treatment.
8/
Take home message?
1. Absolute risk to individual patients is low (number of person-years of exposure needed for 1 additional patient to be harmed 454 for # for 10,000g)
2. Patients should not be worried about short exposures.
Take home message?
1. Absolute risk to individual patients is low (number of person-years of exposure needed for 1 additional patient to be harmed 454 for # for 10,000g)
2. Patients should not be worried about short exposures.
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3. Clinicians should think about switching to non-steroid options if patients needing long term treatment.
4. Clinicians may want to think about bone-protection in patients with long history of chronic inflammatory skin diseases and thus high cumulative TCS dose.
End
3. Clinicians should think about switching to non-steroid options if patients needing long term treatment.
4. Clinicians may want to think about bone-protection in patients with long history of chronic inflammatory skin diseases and thus high cumulative TCS dose.
End
