Steroid Induced

What are steroid medications?

Steroid medications, often called corticosteroids, include medications like prednisone and cortisone. Steroids can be prescribed in many ways but they are most commonly taken by mouth or inhaler. Steroid medications are medically necessary to treat many conditions and diseases. The most common diseases requiring steroid treatment are asthma, inflammatory bowel disease, lupus, multiple sclerosis, and rheumatoid arthritis. 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, vitamin D, and bone. This can lead to bone loss, osteoporosis, and broken bones. When steroid medications are taken for more 3 months, bone loss can happen rapidly. It is important to know that not all people who take steroid medications lose bone. There are different rates of bone loss among individuals taking steroid medications. The exact reasons for these differences are unknown but probably include differences in the steroid dose, the effect of certain underlying disease on bone loss, and perhaps some people are genetically more susceptible to the effects of steroid medications.

When do steroid medications cause bone loss?

Bone loss occurs most rapidly in the first 6 months after starting oral steroid medication. After 12 months of chronic steroid use, there is a slower loss of bone. Inhaled steroids are less likely to cause bone loss than steroids taken by mouth. However, in higher doses, inhaled steroids may also cause bone loss. Steroid medications used for only a few days or applied to the skin are not associated with bone loss.

What is the risk for broken bones when taking steroid medications?

Steroid medications can increase the risk for fractures (broken bones) that occur most commonly in the spine and ribs. Steroid medications (taken by mouth) equal to or more than 5 mg of prednisone daily taken for 3 months or more is considered a risk for fractures. Fracture risk increases as the daily dose of steroid medication increases. A person taking steroid medication is more than twice as likely to have a spine fracture compared to a person not taking steroids. Postmenopausal women who take steroid medications for longer than six months have the greatest risk of bone loss. Almost 1 in 3 postmenopausal women who routinely take steroid medications will have a spine fracture.

What will happen to my risk for fracture after taking steroid medications?

Your should never change the way you take your medication until you speak to your healthcare provider. If 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.

How do I know if I am at risk for osteoporosis?

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 provider 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 longer than three months.

How can I promote stronger bones if I take steroid medications?

There are some very simple steps to take to help protect your bones:

Eat a variety of healthy (nutrient-rich) foods. Make half your plate vegetables and fruit, add lean protein, include whole grains, select heart-healthy fats, and remember to include a calcium-rich food or drink at each meal. For more information about healthy food choices, go to www.choosemyplate.gov

Reach and maintain a healthy weight. Eat the amount of calories and protein you need. The amount that you need will depend on your height, weight, age, and medical condition.

Get the calcium you need. It is recommended that healthy adults consume 1000 to 1200 milligrams (mg) of calcium each day. If you have a medical condition that interferes with the way your body uses calcium, your healthcare provider may recommend slightly more. It is best to get calcium from the foods you eat. It is important to only eat the calcium rich foods you tolerate and/or those that are permitted if you are on a special diet. Foods rich in calcium such as low fat dairy foods (milk, yogurt, cheese), dark green leafy vegetables (bok choy, broccoli, collard greens, kale, mustard greens, and turnip greens), canned fish (sardines, salmon) eaten with bones, or calcium-fortified (with calcium added) foods. The body best uses calcium when it is spaced out through the day. Try to eat a calcium rich food that you can tolerate at each meal. If you think that you are not getting the recommended amount of calcium in the foods you eat, it is important to consult with your healthcare provider to find out if a calcium supplement is right for you. Do not take a calcium supplement without the advice of your healthcare provider. Consuming too much calcium may be harmful.

Get the recommended amount of vitamin D. It is important to eat only the vitamin D foods you tolerate and/or those that are permitted if you are on a special diet. There are only a few good natural sources of vitamin D including fatty fish such as catfish, eel, mackerel, salmon, sardines, tuna and shiitake mushrooms. Small amounts of vitamin D are added to all cow’s milk, some types of beverages (almond, coconut, rice, or soy beverages and orange juice), yogurt, cheese, and nutrition bars. Adults under 50 years of age should consume 400-800 international units (IU) or 10-20 micrograms (mcg) of vitamin D daily. Adults 50 years of age and above should consume 800-1000 IU or 20-25mcg daily. Your healthcare provider may recommend more vitamin D than above stated amounts based on your individual needs.

Be physically active. Your bones get stronger and denser when you make them work. Walking, climbing stairs, and dancing are impact (or weight-bearing) exercises that strengthen your bones by moving your body against gravity when you are standing. Resistance exercises such as lifting weights or using exercise bands strengthens your bones and your muscles too! Tai Chi is an example of physical activity that improves posture and balance to help decrease the risk for falls and fractures. Exercise can be easy; try 10 minutes at a time, adding the minutes up to reach your goal.

Don’t smoke. If you do, STOP. Call 1-800-NYQUITS for information about how to quit.

Limit alcohol. Before drinking alcohol, it is important to speak to your healthcare provider about possible interactions with your medication or your medical condition. Too much alcohol can be harmful for your bones and your overall health.

Take action to prevent falls. Most broken bones occur as a result of a fall that can be prevented. Some actions to prevent falls at home include using nightlights, removing or securing scatter rugs, and getting rid of clutter.

Are there medications to protect bone during steroid therapy?

If you are taking steroid medication on a regular basis, these important actions for stronger bones are often not enough to protect your bones. Medication may be needed to stop bone loss or prevent broken bones. Your healthcare provider will help you decide if you need an osteoporosis medication. The decision will depend upon a number of factors including your BMD test results, the expected dose and duration of steroid treatment, and the evaluation of other risk factors for osteoporosis. The U.S. Food and Drug (FDA) has approved number of medications to prevent bone loss and reduce the risk of fractures related to osteoporosis for individuals who take chronic steroid medications.