Steroid Induced

What are steroid medications?

Steroid medications, often called glucocorticoids or corticosteroids, include medications like prednisone and cortisone. Glucocorticoids can be prescribed to be taken in many ways but they are most commonly given by mouth or inhaler. Steroid medications are medically necessary to treat many conditions and diseases. The most common diseases requiring steroid treatment are asthma, rheumatoid arthritis, lupus, inflammatory bowel disease, and multiple sclerosis. It is important to follow the recommendations of your healthcare provider regarding steroid use and to discuss the actions you can take to protect and promote strong bones.

What effects do steroids have on bone?

Steroid medications have major effects on the metabolism of calcium and bone. This can lead to bone loss, osteoporosis and broken bones. When steroid medications are used in high doses, bone loss can happen rapidly, up to as much as 15% per year. It is important to know that not all patients who take steroid medications lose bone. There are different rates of bone loss among individuals on corticosteroids. The exact reasons for these differences are unknown but probably include differences in steroid dose, the effect of certain underlying disease on bone loss and perhaps some people are genetically more susceptible to the effects of corticosteroids. Postmenopausal women who take steroid medications for longer than six months have the greatest risk of bone loss.

Bone loss occurs most rapidly in the first 6 months after starting oral steroid medications. After 12 months of chronic steroid use, there is a slower loss of bone. Some people are concerned about the effects of inhaled steroids. Inhaled steroids are less likely to cause bone loss than steroids taken by mouth. However, in higher doses, inhaled steroids may also result in bone loss.

The major impact of steroid medication on bone is fractures (broken bones) that occur most commonly in the spine and ribs. Almost 30% of postmenopausal patients who routinely take steroid medications will have a spine fracture. A person on steroids is more than twice as likely to have a spine fracture as compared to a person not taking steroids. Fracture risk increases as the daily dose of steroid medication increases. When your healthcare provider determines that it is time to stop taking your steroid medication, it is expected that your fracture risk will reduce after the medication is discontinued. You should speak to your healthcare provider first before you stop or change your medication.

It is important for you to assess all of your personal risk factors for osteoporosis. Choose the appropriate NYSOPEP Osteoporosis Risk Assessment, "Osteoporosis Risk Assessment for Premenopausal Women", for "Postmenopausal Women", or "for Men" to help you better understand your risk factors for bone loss or osteoporosis. Consult your healthcare providerl to discuss your risk factors and to find out if getting a bone mineral density test (BMD test) is right for you. It is often recommended to get a BMD test before starting to take steroid medications for a period of longer than three months.

Are there medications to protect bone during steroid therapy?

Over the last 10 years, many research studies have investigated :the use of various osteoporosis medications to reduce bone loss resulting from the use of steroid medications. As a result of extensive research, The Federal Drug Administration (FDA) has approved:

• Alendronate (Fosamax), risedronate (Actonel), zoledronic acid (Reclast) and teriparatide (Forteo) for the treatment of steroid-induced osteoporosis in adults (men and women). Alendrondate (Fosamax), risedronate (Actonel) and zoledronic acid (Reclast) are bisphosphonate medications that prevent further bone loss and reduce the risk for osteoporosis-related fractures resulting from the use of steroid medications. Teriparatide (Forteo) is an anabolic medication that decreases bone turnover, increases bone mineral density, rebuilds the microarchitectural structure of bone and reduces the risk for fractures related to osteoporosis. Forteo cannot be taken by patients whose bones are still growing, the pediatric and young adult populations. 
• Risedronate (Actonel) and zoledronic acid (Reclast) for the prevention of bone loss and osteoporosis in men and women with medical conditions necessitating longterm steroid treatment.

How do I know if I need an osteoporosis medication?

Prevention and treatment of osteoporosis and related fractures should always include a nutrient rich diet, adequate calcium and vitamin D, regular physical activity, safety strategies to prevent falls, avoidance of smoking and limited consumption of alcohol. If you are taking chronic steroid medication, these important lifestyle modifications alone are often not enough. Medication may be needed to stop bone loss or fractures. Your healthcare provider will help you evaluate whether or not you need an osteoporosis medication.

Postmenopausal women taking steroid medications are at the greatest risk for rapid bone loss and consequent fracture and therefore should be actively considered for a medication to prevent bone loss. When men and premenopausal women need steroid treatment, the decision to use a drug to prevent bone loss is less clear. The decision will depend upon a number of factors including the BMD test results (before steroids are started), the expected dose and duration of steroids, and evaluation of other risk factors for osteoporosis in these individuals.