High-dose treatment with vitamin A analogues and risk of fractures

Abstract

Objective: To study fracture risk associated with use of systemic vitamin A analogue (isotretinoin and acitretin) treatment. Design: Case-control study. Setting: Nationwide registry. Participants: A total of 124 655 patients with fractures (cases) and 373 962 age- and sex-matched controls. Main Outcome Measure: Incidence of fractures in patients with and without exposure to systemic vitamin A analogues. Confounder control was performed for social variables, contacts with hospitals and general practitioners, alcoholism, and a number of other variables known to potentially affect fracture risk, including use of systemic, intramuscular, and topical corticosteroids and antiepileptic drugs and comorbid conditions. Results: No trend in risk of any fracture or of hip, forearm, or spine fractures was present with increasing doses or durations of treatment with vitamin A analogues. Subdividing vitamin A analogues into isotretinoin and acitretin did not change the results. Conclusion: Risk of fracture is not associated with vitamin A analogue treatment. ©2010 American Medical Association. All rights reserved.