Steroids are used to treat a variety of conditions, from lupus to rheumatoid arthritis. A potential side effect of taking these medications long-term is developing osteoporosis.
Osteoporosis is a condition that affects the strength and structure of the bones. It affects both the mineral density and mass of the bones, which leads to an increased risk of broken bones (fractures). These are
Steroid use is one possible cause of osteoporosis. Here’s how these two things are linked, what the treatment for osteoporosis entails, and what measures you can take to prevent this disease.
Steroids mimic naturally occurring hormones that keep cells healthy, reduce inflammation, and promote growth. While helpful, these medications can affect how the body accesses its stores of calcium and vitamin D, which are essential to building strong bones.
When a person uses steroids long-term, their bones may become weak or brittle, leading to broken bones and bone loss. Steroids also activate the cells that weaken bones, slow the cells that build new bones, and change the levels of estrogen and testosterone in the body.
How much the bones are impacted depends on the length of time someone is on steroids and the dosage. For example, people who are on high doses of steroids may experience a
Steroids are typically taken orally (by mouth), through an inhaler or nasal spray (breathed in), injected, or applied to the skin or eyes. They’re used to treat many conditions, including asthma, rheumatoid arthritis, lupus, inflammatory bowel disease, and multiple sclerosis.
Types of corticosteroids include:
Oral steroids pose the
There’s
It appears that steroids that are applied topically to the skin are less likely to lead to osteoporosis.
Steroids that may cause osteoporosis
| Type of steroid | Risk |
|---|---|
| steroid tablets | may cause bone loss if used longer than 3 months; risk increases with dosage |
| steroid injections (vein/muscle) | regular, high dose injections may cause bone issues over time |
| steroid injections (joint) | occasional injections do not cause bone issues; risk increases with frequency |
| steroid inhalers | less likely to cause bone issues, but more research is needed |
| steroid creams | unlikely to affect bone health |
| steroid eye drops | unlikely to affect bone health |
| steroid replacement therapy | unlikely to affect bone health at appropriate dosage |
Before taking steroids, your doctor may suggest a test similar to an X-ray called a DEXA scan to measure your bone density. This way, you have a baseline to measure against to monitor for any loss during the course of your treatment.
If you develop osteoporosis or need to be on steroids long-term, your doctor may prescribe medications that prevent bone loss or promote bone growth:
- Supplementation: Some supplements support natural bone growth, such as vitamin D (
800 IU ) and calcium (1000 mg ). - Antiresorptive therapy: This
first-line treatment therapy helps to reduce the breakdown of the bones and includes taking bisphosphonates (Fosamax, Boniva, and others) either orally or intravenously. - Anabolic therapy: This treatment promotes bone formation and includes taking teriparatide (Forteo) as an injection under the skin.
- Hormone replacement therapy: Hormone replacement therapy, particularly using estrogen and progesterone after postmenopause, helps improve bone density.
- Other treatment options: Other treatments, like tamoxifen and raloxifene, may have an estrogen effect and protect bones.
Discuss the risks of steroid medication use with your doctor. For many people, the benefits outweigh the risks, especially if you take your medications as prescribed and monitor your bone density.
Some things you can do to prevent osteoporosis:
- Exercise regularly: Focus on weight-bearing activities like walking and lifting weights.
- Examine your substance use: Avoid smoking, and drink alcohol in moderation.
- Eat a balanced diet: Eat healthy foods that include foods that are high in vitamin D, calcium, and protein.
- Take prescribed medications as directed: Take all prescribed medication as instructed by a doctor or healthcare professional to help protect against fractures.
Stopping steroid medications may
It’s important to communicate with your doctor about how to take your medications and when to stop them. Your doctor may even suggest using osteoporosis medications for
If you do develop osteoporosis, consider making changes to your routine, like wearing supportive shoes, avoiding walking on slippery or hazardous surfaces, or using handrails to protect against falls and fractures.
How soon after taking steroids can osteoporosis develop?
Most bone loss happens within the
What dosage causes the most issues?
Experts share that taking as low as 2.5 milligrams (mg) of prednisone each day for 3 months or longer puts people at risk. The risk increases with higher dosages.
Who is at the highest risk?
Adults between the ages of
Those over the age of 50 are more likely to break a bone due to osteoporosis, 1 in 2 women and up to 1 in 4 men.
Osteoporosis is
If you’re taking steroids and have concerns about your bone health, reach out to your doctor to discuss your risks and any preventive measures that may help.
The good news is that with preventive medications and certain lifestyle changes, you may avoid long-term complications.