Naing, C., and Whittaker, M.A. (2017) Anabolic steroids for treating pressure ulcers. Cochrane Database of Systematic Reviews, 6. CD011375. pp. 1-35.

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Abstract

Review Question: We reviewed the evidence about the effect of anabolic steroids (medicines designed to increase muscle mass) for treating people with pressure ulcers.

Background: Pressure ulcers are also known as bed sores, pressure sores or decubitus ulcers. Pressure ulcers are a common medical problem amongst people confined to a bed or wheelchair for long periods of time. Lack of movement and sustained pressure on the skin over bony parts of the body such as the hips, heels, lower back and elbows can cause the skin to break down and an ulcer to form. People at risk of pressure ulcers include those with spinal cord injuries, elderly people and people with long-term illnesses. Pressure ulcers affect quality of life and can have serious complications such as infection, if they do not heal. As well as being painful and troublesome to patients, pressure ulcers represent a significant cost to healthcare systems due to the nursing time involved in treatment. There are a variety of treatments that are usually used for pressure ulcers including wound dressings and specially-designed beds and cushions to reduce pressure on certain areas of the body.

Anabolic steroids are a type of medicine used to increase muscle mass. They can be used as an alternative to, or alongside, conventional treatments for pressure ulcers. They are thought to promote the growth of skeletal muscle and to restore muscle mass, which could help pressure ulcers to heal. However, it has been found that oxandrolone (a commonly-used anabolic steroid) can cause potential liver damage. Anabolic steroids may also increase the risk of heart attack or stroke. We wanted to find out whether anabolic steroids were effective in treating pressure ulcers, and if they had any harmful effects.

Study characteristics: In March 2017, we searched for randomised controlled trials, which compared the use of anabolic steroids with other treatments for pressure ulcers. We found only one trial involving a total of 212 participants. This trial compared the effects of an anabolic steroid (oxandrolone capsules) with a placebo (dummy treatment containing no active medicine) on pressure ulcer healing in people with spinal cord injuries. The participants were mostly male (98.2%) with a mean age of 58.4 years in the oxandrolone group, which was comparable with the participants in the placebo group (male: 100%; mean age: 57.3 years). The trial was conducted over 24 weeks with a further follow-up for eight weeks.

Key results: The trial was ended early as the trial authors deemed that the interim results suggested that there was unlikely to be a benefit from treatment with oxandrolone. Because of the limited data available from one trial, we remain uncertain whether anabolic steroids have beneficial effects on pressure ulcer healing, whether the treatment causes increased serious adverse events and if the treatment may increase the risk of non-serious adverse events.

Quality of the evidence: Overall, the evidence from this study was judged to be of very low quality. More, better-designed studies are necessary to provide evidence as to whether anabolic steroids are beneficial or not in treating pressure ulcers.

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