Osteoporosis and prevention of steroid-induced osteoporosis

Updated 9/02/17.

What is osteoporosis?

Osteoporosis is a condition that weakens bones, making them fragile and more likely to break.

What causes osteoporosis?

Around the age of 35 we start losing bone density, but this happens more quickly to some than others. It is this loss of bone density that makes the bones more fragile.

Who is most at risk?

There are numerous things that can increase your risk of developing osteoporosis. Some of these include:

  • Getting older.
  • Family history of osteoporosis, particularly history of a hip fracture in a parent.
  • Taking corticosteroids (steroids) for more than 3 months, particularly more than 20mg per day. Osteoporosis caused by steroids is called ‘steroid-induced osteoporosis’.
  • Long-term use of certain medications which can affect bone strength or hormone levels.
  • Having certain health conditions, e.g inflammatory conditions, hormone-related conditions, or conditions that cause problems with malabsorption.
  • Smoking.
  • Heavy drinking.
  • Being post-menopausal, or starting the menopause before the age of 45 years.
  • Being underweight.
  • Being immobile.

What can be done to reduce your risk of developing steroid-induced osteoporosis?

Specific measures to reduce the chance of steroid-induced osteoporosis should be considered for patients that have taken or are expected to take 7.5 mg or more of prednisone or prednisolone each day for a period of three months or longer (Oakley, 2016). These measures include:

1. A DEXA bone scan.

A DEXA bone scan measures bone density. Bone density gives an indication of the risk of fracture due to bone loss. A scan may sometimes, but not always, be arranged before you start systemic steroids, and will then be repeated every year or as recommended by your doctor.

2. Dietary changes and medications.

These include:

  • Healthy eating, including foods rich in calcium and vitamin D (NHS Choices, 2016).
  • Bisphosphonates (alendronate, etidronate, zolidronic acid); these are prescribed for patients at higher risk of fracture (NHS Choices, 2016; Oakley, 2016).

Calcium and vitamin D supplements, and oestrogen are no longer routinely prescribed or recommended to prevent osteoporosis, as the risks can outweigh the benefits (Oakley, 2016). However, if needed, a vitamin D supplement 10 mcg (micrograms) is perfectly safe (NHS Choices, 2016).

3. Other preventative measures.

  • Stop smoking.
  • Minimal alcohol intake.
  • Regular weight-bearing exercise.

Further information.

NICE Guidelines (2017) Osteoporosis: assessing the risk of fragility fracture (online). Published in Aug 2012, and updated Feb 2017.

NHS Choices (2016) DEXA (DXA) scan (online).

Steroid medication: what do I need to know?

References.

NHS Choices (2016) Osteoporosis (online).

Oakley, A. (2016) Systemic Steroids. DermNet NZ (online). Published in 1997, and updated Feb 2016.

© 2012-2017 Sweet’s Syndrome UK

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