Are steroids prescribed for bone fractures?

From the Guidelines

Steroids are not typically prescribed for routine bone fractures, as they can impair bone healing and increase the risk of infection. The standard treatment for fractures includes immobilization (casts, splints, or braces), pain management with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen, and proper alignment of the bone. In some specific cases, corticosteroids might be used to reduce inflammation around the fracture site if there is significant soft tissue swelling that could impair healing or cause complications, but this is not common practice. For certain complex fractures involving nerve compression or severe inflammation, a short course of oral prednisone (typically 5-10mg daily for 3-5 days) might be considered, but only under specific medical supervision, as supported by the 2023 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis 1. The focus of fracture treatment remains on proper alignment, immobilization, adequate nutrition (particularly calcium and vitamin D), and appropriate physical therapy during recovery. Key considerations include:

• Assessing fracture risk using tools like FRAX, which takes into account the dose of glucocorticoids, as mentioned in the 2017 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis 1.
• Using bisphosphonates as first-line therapy for preventing fractures in patients at high risk, as recommended by the EULAR/EFORT guidelines for the management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures 1.
• Ensuring adequate calcium and vitamin D intake, as emphasized in the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1. Overall, the management of bone fractures prioritizes evidence-based treatments that minimize morbidity, mortality, and improve quality of life, as supported by the most recent and highest quality studies, including those from 2023 1.

From the Research

Steroid Prescription for Bone Fractures

• Steroids are not typically prescribed for bone fractures, but rather to reduce inflammation and swelling in certain cases, such as spinal cord injuries 2.
• Systemic steroid therapy can lead to a loss of bone density, which increases the risk of fractures 3.
• There is no firm evidence that steroids are effective in preventing fractures, and their use is generally restricted to situations where the benefits outweigh the risks 3.

Effects of Steroids on Bone Density and Fracture Risk

• Long-term steroid use can lead to a decrease in bone density, which increases the risk of fractures 4, 5.
• The risk of fracture is dose-dependent, with higher doses of steroids leading to a greater increase in fracture risk 5.
• The risk of fracture declines rapidly after cessation of steroid treatment 5.

Alternative Treatments for Bone Fractures

• Calcium and vitamin D supplements may be recommended to help maintain bone density in patients at risk of osteoporosis 3.
• Other treatments, such as bisphosphonates and hormone replacement therapy, may also be effective in slowing the decline in bone density associated with steroid therapy 3.
• Non-steroidal anti-inflammatory drugs (NSAIDs) and selective Cox-2 inhibitors may impair bone healing, but the clinical significance of this effect is unclear 6.