Impact of Chronic Levothyroxine, Corticosteroid, and Antiepileptic Use on Osteoporosis Prevalence in Adults Aged 50–90 Without Fracture History

Location

LSUHSC-NO Center for Advanced Learning and Simulation

Document Type

Presentation

Start Date

21-6-2025 10:20 AM

End Date

21-6-2025 11:15 AM

Publication Date

June 2025

Description

Introduction: Osteoporosis is a prevalent condition in older adults, yet current screening guidelines primarily target individuals with a history of fractures, potentially overlooking those on medications that elevate osteoporosis risk. This study examines the association between chronic use of levothyroxine, corticosteroids, and antiepileptics with osteoporosis prevalence in adults aged 50–90 years without prior fractures. We hypothesized that individuals using these medications would exhibit a higher prevalence of osteoporosis compared to non-users.

Methods: This retrospective cohort study analyzed electronic health record data from 2011 to 2023, including 446,075 patients aged 50–90 years. The exposed cohort consisted of individuals prescribed levothyroxine, corticosteroids, or antiepileptics, while the control cohort included non-users. Osteoporosis was identified using ICD-9 codes (733.01, 733.02, 733.03, 733.09, V82.81, V13.51, V49.81) and ICD-10 codes (Z13.820, Z78.0, Z87.310, M80, M81, M81.0, M81.6, M81.8). Exclusion criteria included prior osteoporotic fractures or conditions predisposing patients to fractures. Osteoporosis prevalence and relative risk (RR) were stratified by sex and age. Statistical analyses included chi-square tests and logistic regression (α=0.05).

Results: Following exclusions, 39% of the study population were male and 61% female. Osteoporosis prevalence was significantly higher in the exposed cohort (levothyroxine: 55.42%, corticosteroids: 35.51%, antiepileptics: 35.37%) versus controls (25.92%). The relative risk of osteoporosis was highest among levothyroxine users (RR=2.14, p<0.001), followed by corticosteroids (RR=1. 37) and antiepileptics (RR=1.36). Women in the exposed group exhibited greater osteoporosis prevalence, with levothyroxine users having the highest odds ratio (OR=3.00 in women vs. OR=2.19 in men). Osteoporosis prevalence increased with age, with the highest rates in older exposed individuals.

Discussion: : Findings indicate a strong association between chronic levothyroxine, corticosteroid, and antiepileptic use and osteoporosis, particularly among women. The increased prevalence suggests a need for improved osteoporosis screening and preventive interventions in high-risk populations. Limitations include reliance on diagnostic coding and potential confounders such as medication adherence and comorbidities. Further research is needed to assess causality and the impact of early intervention.

Significance/Clinical relevance: These findings support expanding osteoporosis screening guidelines to include patients on long-term levothyroxine, corticosteroids, and antiepileptics, potentially improving early detection and prevention strategies.

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Jun 21st, 10:20 AM Jun 21st, 11:15 AM

Impact of Chronic Levothyroxine, Corticosteroid, and Antiepileptic Use on Osteoporosis Prevalence in Adults Aged 50–90 Without Fracture History

LSUHSC-NO Center for Advanced Learning and Simulation

Introduction: Osteoporosis is a prevalent condition in older adults, yet current screening guidelines primarily target individuals with a history of fractures, potentially overlooking those on medications that elevate osteoporosis risk. This study examines the association between chronic use of levothyroxine, corticosteroids, and antiepileptics with osteoporosis prevalence in adults aged 50–90 years without prior fractures. We hypothesized that individuals using these medications would exhibit a higher prevalence of osteoporosis compared to non-users.

Methods: This retrospective cohort study analyzed electronic health record data from 2011 to 2023, including 446,075 patients aged 50–90 years. The exposed cohort consisted of individuals prescribed levothyroxine, corticosteroids, or antiepileptics, while the control cohort included non-users. Osteoporosis was identified using ICD-9 codes (733.01, 733.02, 733.03, 733.09, V82.81, V13.51, V49.81) and ICD-10 codes (Z13.820, Z78.0, Z87.310, M80, M81, M81.0, M81.6, M81.8). Exclusion criteria included prior osteoporotic fractures or conditions predisposing patients to fractures. Osteoporosis prevalence and relative risk (RR) were stratified by sex and age. Statistical analyses included chi-square tests and logistic regression (α=0.05).

Results: Following exclusions, 39% of the study population were male and 61% female. Osteoporosis prevalence was significantly higher in the exposed cohort (levothyroxine: 55.42%, corticosteroids: 35.51%, antiepileptics: 35.37%) versus controls (25.92%). The relative risk of osteoporosis was highest among levothyroxine users (RR=2.14, p<0.001), followed by corticosteroids (RR=1. 37) and antiepileptics (RR=1.36). Women in the exposed group exhibited greater osteoporosis prevalence, with levothyroxine users having the highest odds ratio (OR=3.00 in women vs. OR=2.19 in men). Osteoporosis prevalence increased with age, with the highest rates in older exposed individuals.

Discussion: : Findings indicate a strong association between chronic levothyroxine, corticosteroid, and antiepileptic use and osteoporosis, particularly among women. The increased prevalence suggests a need for improved osteoporosis screening and preventive interventions in high-risk populations. Limitations include reliance on diagnostic coding and potential confounders such as medication adherence and comorbidities. Further research is needed to assess causality and the impact of early intervention.

Significance/Clinical relevance: These findings support expanding osteoporosis screening guidelines to include patients on long-term levothyroxine, corticosteroids, and antiepileptics, potentially improving early detection and prevention strategies.