Use of potent or very potent topical corticosteroids (TCSs) in high cumulative amounts was associated with an increase in the risk of osteoporosis and major osteoporotic fracture (MOF), according to the findings of a recently published retrospective cohort study published in JAMA Dermatology.

To determine the association between cumulative exposure of potent and very potent TCSs and osteoporosis and MOF risk, study authors utilized the Danish nationwide registries. They obtained data on 723,251 Danish adults who filled prescriptions for these agents between January 1, 2003, and December 31, 2017.

“Filled prescription data were converted in equipotent doses to mometasone furoate (1mg/g ),” the authors explained. “Patients were considered exposed when they had filled prescriptions of cumulative amounts corresponding to the equivalent of at least 500g of mometasone, using filled prescriptions of 200 to 499g as the reference group.”

Primary outcomes of the analysis included an osteoporosis or MOF diagnosis. Hazard ratios (HRs) with 95% CIs were calculated using Cox proportional hazards regression models and were adjusted for age, gender, socioeconomic status, medication use, and comorbidity.

The average (SD) age of patients included in the study was 52.8 (19.2) years old and 52.8% of the patients were female. Analysis of the data revealed a dose-response association between increased use of potent or very potent TCSs and osteoporosis and MOF risk. “For example, HRs of MOF were 1.01 (95% CI, 0.99-1.03) for exposure to 500 to 999g, 1.05 (95% CI, 1.02-1.08) for exposure to 1000 to 1999g, 1.10 (95% CI, 1.07-1.13) for exposure to 2000 to 9999g, and 1.27 (95% CI, 1.19-1.35) for exposure to at least 10,000g,” the authors stated.

Findings of the study showed a relative risk increase of 3% for osteoporosis and MOF per doubling of the cumulative dose of TCS (HR for both, 1.03; 95% CI, 1.02-1.04). Additionally, data analysis revealed an overall population-attributable risk of 4.3% (95% CI, 2.7-5.8) for osteoporosis and 2.7% (95% CI, 1.7-3.8) for MOF.

Based on these findings, the authors concluded that for patients requiring potent anti-inflammatory therapy on large areas of the body for prolonged periods of time, treatment with corticosteroid-sparing agents should be considered to limit the risk of osteoporosis. They added that for the average TCS user, the absolute risk of osteoporosis remains low.

Disclosure: Multiple authors declared conflicts of interest. Please refer to the original article for a full list of disclosures.


Egeberg A, Schwarz P, Harsløf T, Anderson Y, Pottegard A, Hallas J, et al. Association of potent and very potent topical corticosteroids and the risk of osteoporosis and major osteoporotic fractures. [published online January 20, 2021] JAMA Dermatol. 2021. doi:10.1001/jamadermatol.2020.4968.