Ann Arbor, MI—A short-term course of steroids, used for common conditions ranging from backache to allergy symptoms, might not be as benign as many healthcare professionals assume, a new study suggests.

The report in in the British Medical Journal (BMJ) found that patients using oral corticosteroids were more likely to develop a blood clot or sepsis or to break bones in the months after treatment, compared to those not using the medication.

University of Michigan–led researchers reviewed medical records of 1.5 million adults in the United States with private insurance and determined that the sepsis rate was quintupled, the venous thromboembolism (VTE) rate was nearly tripled, and fracture risk almost doubled. Those increased risks were highest in the first month after a prescription and stayed elevated even 3 months later.

About 20% of the overall study group filled a short-term prescription for oral corticosteroids at some point during a 3-year period.

“Although physicians focus on the long-term consequences of steroids, they don’t tend to think about potential risks from short-term use,” explained lead author Akbar Waljee, MD, MSC, an assistant professor of gastroenterology at the University of Michigan Medical School and a research scientist at the Veterans’ Affairs Ann Arbor Healthcare System. “We see a clear signal of higher rates of these three serious events within 30 days of filling a prescription. We need to understand that steroids do have a real risk and that we may use them more than we really need to. This is so important because of how often these drugs are used.”

Researchers determined that six diagnoses—related to back pain, allergies, and respiratory tract infections—accounted for 50% of the prescriptions for steroids. Half of those were for prepackaged products that gradually taper dosage, but Waljee noted that the relatively high starting doses might not always be necessary. He suggested that individual pills, which are less expensive, might have been a better prescription choice in many cases.

Results also indicate that short-term steroid prescriptions were more commonly used by the oldest segment of the study group, although all of the patients were aged <65 years, and tended to be prescribed more often for females in living in the South and who had multiple health conditions.

Overall, the study determined that 0.05% of those receiving steroids were admitted to a hospital with a primary diagnosis of sepsis, compared with 0.02% percent of nonsteroid users. The difference in rates for VTE was 0.14% compared with 0.09% of nonsteroid users, and for fractures, 0.51% versus 0.39%.

The authors caution that their review was unable to account for all the individual differences between steroid users and nonusers.
 
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