Association between genetic polymorphisms and osteonecrosis in steroid treatment populations: a detailed stratified and dose-response meta-analysis

Abstract

Steroid treatment has become recognized as an important risk factor for avascular osteonecrosis of the femoral head. However, not all patients who receive long-term, high-dose steroids develop osteonecrosis, indicating that there are individual differences in occurrence. We explored the relationship between polymorphisms and steroid-induced osteonecrosis of the femoral head (SONFH) incidence with variables. We used a multilevel mixed-effects logistic regression model, which is an expansion of logistic regression, for each type of steroid, primary disease, drug dose, applied duration, and single-nucleotide polymorphism (SNP). We also conducted a dose-response meta-analysis to analyze the cumulative dosage and SONFH risk in mutation carriers. There were significant correlations between the ABCB1 rs1045642 mutant and SONFH in the prednisone-use and methylprednisolone/prednisone-use populations. The ABCB1 rs2032582 mutant homozygote had a protective effect in the methylprednisolone/prednisolone renal transplant population. For ApoB rs693, mutation increased the incidence of SONFH in prednisone-use and methylprednisolone/prednisolone-use populations and renal transplant patients. For ApoB rs1042031, mutation increased the risk of SONFH in the prednisone-use population. The PAI-1 rs1799768 mutation had a protective effect on the SONFH risk prednisone-use and renal transplant populations. ABCB1 rs1045642 mutations have a protective effect against SONFH, and ApoB rs693 and rs1042031 increase the SONFH risk. Cumulative dosage and treatment duration had little effect on the results. In addition, there was a dose-effect correlation in ABCB1 rs1045642 and rs2032582 mutation carriers.

Controversies in the application of corticosteroids for pediatric septic shock treatment: a preferred reporting items for systematic reviews and meta-analysis-compliant updated meta-analysis

“…Because of the different types of steroids and units of measurement used in the included studies, it was necessary to convert the different types of steroids into an equivalent dose of hydrocortisone. The conversion standard was hydrocortisone 20 mg = methylprednisolone 4 mg = dexamethasone 0.75 mg. [ 16 ] For pediatric medications, the conversion between body weight (BW) and body surface area (BSA) was as follows: in children with a BW less than 30 kg, BSA(m 2 ) = 0.035 × BW(kg) + 0.1; in children with a BW more than 30 kg, the BSA on a 1.15 m 2 basis increased by 0.1 m 2 per 5 kg increase from a 30 kg BW basis. The primary outcome in our analysis was mortality at the last follow-up.…”

Current status of glucocorticoid usage in solid organ transplantation

“…Osteonecrosis of the hip is another side effect of corticosteroids in SOT patients[ 95 ]. Although some studies showed that the cumulative dose of methylprednisolone/prednisolone after kidney transplantation has been a risk factor for avascular osteonecrosis[ 96 , 97 ], a meta-analysis found little correlation between cumulative doses and duration of administration of methylprednisolone/prednisolone and avascular osteonecrosis of the femoral head[ 98 ].…”