Fractures Associated with Corticosteroids for Eczema Treatment (FACET)

Date of Approval
Application Number
Technical Summary

Background: Atopic eczema, a common skin disease characterised by itching and rash, is sometimes treated with oral corticosteroids (OCS). It is well established that OCSs increase fracture risk. Fracture-preventive care medications, like bisphosphonates, can be used to counter OCS’ negative effects on bone health.
People with atopic eczema are prescribed OCSs in different patterns (e.g., continuously or intermittently). We hypothesise that people given intermittent courses of OCSs are less likely to receive adequate fracture-preventive care than people receiving the same cumulative corticosteroid dose continuously, leading to a shortfall in preventive care.
Objectives: We will: 1) describe patterns of OCS use in people with atopic eczema; 2) compare rates of fracture preventive care between intermittent and continuous OCS users in people with atopic eczema who receive high cumulative doses of OCS; 3) compare rates of fractures between intermittent and continuous OCS users in high-cumulative-OCS-dose users with atopic eczema.
Methods: We will initially describe characteristics and patterns of OCS use in adults (18+) with atopic eczema. In older people (>=66 years, bisphosphonate prescribing uncommon in younger people) receiving high cumulative doses of OCS (i.e., >450mg prednisolone equivalent dose within 6 months), we will use Cox regression to estimate hazard ratios, comparing rates of fracture-preventative care and fractures in people with intermittent-OCS use compared to continuous-OCS users. All analyses will be adjusted for potential confounders.
Relevance: If there is a difference in fracture-preventive-care receipt between people on intermittent versus continuous OCS, our results will highlight a gap in appropriate care and inform atopic eczema management.

Health Outcomes to be Measured

Patterns of OCS use; Fracture preventive care (prescriptions for anti-osteoporosis medications); Major osteoporotic fractures (hip, spine, wrist, and pelvis)


Sinead Langan - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Julian Matthewman - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Daniel Prieto-Alhambra - Collaborator - University of Oxford
Kathryn Mansfield - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )


HES Admitted Patient Care;Patient Level Carstairs Index;Practice Level Carstairs Index (Excluding Northern Ireland)