Do steroids cause osteoporosis?

What Is Steroid-Induced Osteoporosis?

Such medications have both direct and indirect effects on bone tissue that lead to bone loss. If you take Prednisone or an equivalent at a dose greater than 2.5 mg per day for more than three months, you are at risk of Glucocorticoid-induced osteoporosis. These drugs reduce the rate of forming new bones. Also, they can interfere with the body’s handling of calcium and affect levels of sex hormones. Either of these problems can lead to more bone loss.

Anyone who is taking Glucocorticoid medications and has other risk factors for osteoporosis increases their risk of developing glucocorticoid-induced osteoporosis and breaking a bone (fracture). You can change some of these risk factors, but not others.

Major risk factors that you cannot change include:

• Older age
• Thin body
• Family history of osteoporosis or osteoporosis -related fracture in a parent or sibling
• Prior fracture due to a low-level injury

Risk factors that you may be able to change include:

• Low levels of sex hormone, mainly estrogen in women (e.g., menopause) and men
• The eating disorder anorexia nervosa
• Cigarette smoking
• Alcohol abuse
• Low calcium and vitamin D levels
• Sedentary (inactive) lifestyle or immobility

Certain medications besides glucocorticoids, including the following:

• Excess thyroid hormone replacement
• The blood thinner heparin
• Some treatments of breast cancer or prostate cancer that reduce sex hormones
• Diseases that can affect bones
  Endocrine (hormone) diseases (hyperthyroidism, hyperparathyroidism)

How Is Glucocorticoid-Induced Osteoporosis Diagnosed?

You can learn if you have osteoporosis by having a simple test that measures bone mineral density — sometimes called BMD. This is the amount of bone you have in a given area and is measured in different parts of your body. Often the measurements are at your spine and your hip, including a part of the hip called the femoral neck, at the top of the thigh bone (femur).

How Is Glucocorticoid-Induced Osteoporosis treated?

Anyone taking glucocorticoid medicine must get enough calcium and vitamin D. It is recommended that you should take at least 800 mg of calcium and 800 to 1,000 International Units (called IU) of vitamin D supplements each day. Your doctor may measure the vitamin D level in your blood to find out if you need more vitamin D supplementation.

Some people also will need medication. When it comes to a drug class called bisphosphonates, Alendronate, Risedronate and Zoledronic acid are FDA approved for both the prevention and treatment of glucocorticoid-induced osteoporosis. Teriparatide, a different type of drug, also is approved for treatment of glucocorticoid-induced osteoporosis. This man-made form of parathyroid hormone helps stimulate bone formation.

Can Prednisone-induced osteoporosis be reversed?

Loss of bone mineral density occurs rapidly but can be reversed. Bone loss appears to be greatest in the first two to three months of corticosteroid use. Fracture risk returns to baseline when steroid treatment is discontinued, with the risk reduction occurring mostly within the first year of stopping.

Glucocorticoid-Induced Osteoporosis Prevention Tips

If you take Glucocorticoid medicine for any length of time, you should start taking calcium and vitamin D supplements at the doses recommended in the prior section. Work with your doctor to help use the smallest dose of glucocorticoid for the shortest duration possible that will still keep your disease under control.

Patients taking glucocorticoid medicine should…

• Be physically active and do weight-bearing exercises, like walking, most days each week
• Change lifestyle choices that raise your risk of osteoporosis, such as quitting smoking
• Implement strategies to help decrease your risk of falling, which raises the risk of fractures
• Get DXA testing of your BMD

If you have low bone density and a high risk of breaking a bone, your doctor may suggest medicine to prevent your bones from weakening further. The most serious health consequence of any type of osteoporosis is fracture. Spine and hip fractures especially may lead to chronic pain, long-term disability and even death. Daily calcium and vitamin D supplements can help prevent loss of bone mass. Calcium alone is not effective. An endocrinologist can advise about other treatment options.