Population-based assessment of adverse events associated with long-term glucocorticoid use

Arthritis Rheum. 2006 Jun 15;55(3):420-6. doi: 10.1002/art.21984.


Objective: The frequency of many adverse events (AEs) associated with low-dose glucocorticoid use is unclear. We sought to determine the prevalence of glucocorticoid-associated AEs in a large US managed care population.

Methods: Using linked administrative and pharmacy claims, adults receiving >or=60 days of glucocorticoids were identified. These individuals were surveyed about glucocorticoid use and symptoms of 8 AEs commonly attributed to glucocorticoid use.

Results: Of the 6,517 eligible glucocorticoid users identified, 2,446 (38%) returned the mailed survey. Respondents were 29% men with a mean +/- SD age of 53 +/- 14 years; 79% were white and 13% were African American. Respondents had a mean +/- SD of 7 +/- 3 comorbid conditions and were prescribed a mean +/- SD prednisone-equivalent dosage of 16 +/- 14 mg/day. More than 90% of individuals reported at least 1 AE associated with glucocorticoid use; 55% reported that at least 1 AE was very bothersome. Weight gain was the most common self-reported AE (70% of the individuals), cataracts (15%) and fractures (12%) were among the most serious. After multivariable adjustment, all AEs demonstrated a strong dose-dependent association with cumulative glucocorticoid use. Among users of low-dose therapy (<or=7.5 mg of prednisone per day), increasing duration of use was significantly associated with acne, skin bruising, weight gain, and cataracts.

Conclusion: The prevalence of 8 commonly attributed self-reported glucocorticoid-associated AEs was significantly associated with cumulative and average glucocorticoid dose in a dose-dependent fashion. Physicians should be vigilant for glucocorticoid-related AEs and should counsel patients about possible risks, even among low-dose long-term users.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Oral
  • Cataract / chemically induced
  • Cataract / epidemiology*
  • Dose-Response Relationship, Drug
  • Female
  • Fractures, Spontaneous / chemically induced
  • Fractures, Spontaneous / epidemiology*
  • Glucocorticoids / adverse effects*
  • Humans
  • Iatrogenic Disease / epidemiology*
  • Male
  • Managed Care Programs
  • Middle Aged
  • Population Surveillance*
  • Prevalence
  • Surveys and Questionnaires
  • United States / epidemiology


  • Glucocorticoids