Evidence suggests adults with atopic eczema have increased fracture risk. However, it is unclear whether oral corticosteroids explain the association. The objective of this study was to assess to what extent oral corticosteroids mediate the relationship between eczema and fracture risk. We performed a cohort study using English primary care (Clinical Practice Research Datalink) and hospital admissions (Hospital Episode Statistics) records (1998-2016). Participants were adults (18+) with eczema matched (on age, sex, and general practice) with up to five adults without eczema. We estimated Hazard ratios (HRs) from Cox regression for specific major osteoporotic fractures (hip, spine, pelvis, wrist) and for any-site fracture comparing individuals with eczema to those without eczema, adjusting for six different definitions of time-updated oral corticosteroid use (ever any prescription; ever high dose; recent, cumulative, current, peak dose). We identified 526,808 individuals with eczema and 2,569,030 without. We saw evidence of an association between eczema and major osteoporotic fractures (e.g., spine HR 1.15 99%CI 1.08–1.22; hip HR 1.11 99%CI 1.08–1.15) that remained after additionally adjusting for oral corticosteroids (e.g., cumulative corticosteroid dose: spine HR 1.09 99%CI 1.03–1.16; hip HR 1.09 99%CI 1.06–1.12). Fracture rates were higher in people with severe eczema compared to people without even after adjusting for oral corticosteroids (e.g., spine HR [99%CI]: confounder adjusted 2.31 [1.91–2.81]; additionally adjusted for cumulative dose 1.71 [1.40–2.09]). Our findings suggest that little of the association between atopic eczema and major osteoporotic fractures is explained by oral corticosteroid use.

ESDR059 - Atopic-eczema-associated fracture risk and oral corticosteroids: a population-based cohort study

50th Annual Meeting of the European Society for Dermatological Research. VIRTUAL MEETING