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.

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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 most common in the wrist, spine, and hip.

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 faster decline in bone health.

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 highest risk to bone health because they’re absorbed systemically (into the whole body), whereas the other forms are used on specific areas of the body for treatment and, therefore, have reduced side effects in other parts of the body.

There’s less evidence to support that steroids that are inhaled contribute to osteoporosis than those taken orally. That said, high doses of inhaled steroids may lead to bone issues.

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 steroidRisk
steroid tabletsmay 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 inhalersless likely to cause bone issues, but more research is needed
steroid creamsunlikely to affect bone health
steroid eye dropsunlikely to affect bone health
steroid replacement therapyunlikely 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:

Stopping steroid medications may lessen your risk of fractures. That said, even previous use of steroids may affect your bone health. And experts don’t agree on whether steroid-related osteoporosis is reversible.

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 6 to 12 months after discontinuing your use of steroids for added protection.

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 first 6 months after starting steroids. After a year of use, bone loss may slow down.

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 20 and 45 years are at the highest risk of osteoporosis related to steroid use. Other health factors in a person’s life (genetics, sex, and age) may also increase the chance of developing osteoporosis.

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 sometimes called a “silent” disease because you can have it without any notable symptoms until you break a bone.

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.