Can Prednisone Increase Osteoporosis Risk?

Prednisone is a corticosteroid that is commonly used to treat rheumatoid arthritis (RA). In many cases, prednisone is used as a short-term treatment to calm a flare. While certain side effects are well-known, such as weight gain and unwanted hair growth, these effects are reversible when you stop taking the drug.

However, there is evidence that long-term prednisone use may have more serious side effects, including osteoporosis.

What is osteoporosis?

Osteoporosis is a loss of bone density or a “thinning” of the bones. It makes bones weaker and can increase your risk of a break or fracture. You will not always feel the symptoms of osteoporosis, which is why it is called a “silent disease.” Unfortunately, many people do not even know they have it until they suffer a fracture.1

These fractures can be dramatic, like a fall that breaks a bone in the hip or wrist. However, osteoporosis can also affect the bones of the spine (also called vertebrae). When this happens, it can take the form of a stooped or hunched posture, loss of height, or back pain.1

While osteoporosis is most common in older women, they are not the only ones who are affected by it. If you take prednisone, you also can be at risk for osteoporosis, no matter your age or gender.2

Between 30 and 60 percent of osteoporosis cases are due to certain conditions or prescription drugs that people take. Taking corticosteroid drugs, such as prednisone, for a long time can increase the risk of osteoporosis, whoever you are. That is why it is so important that people with RA and the doctors who treat it are aware of this risk.2

How can prednisone weaken bones?

Corticosteroids can raise the risk of osteoporosis in two ways:3

  • They reduce the body’s ability to absorb calcium. Calcium is the mineral in foods like milk and yogurt that help us grow and maintain bones.
  • They make bones break down faster, speeding up the natural process that many of us naturally go through as we age.

Both of these risks can increase the longer you take corticosteroids.3

A recent study presented at the American Society for Bone and Mineral Research (ASBMR) annual meeting took a closer look at what prednisone can do to the bones of people with RA.

Researchers found that daily doses of prednisone of 7.5 mg per day or less may specifically increase the risk of vertebral fracture (breakage of the bones of the spine). Although bone loss was also seen in other parts of the body, such as the hands and the hips, bone breakage was most likely to happen in the spine. The study also found that the higher the dose of prednisone, the higher the risk of bone loss and breakage.4

Who is most at risk of osteoporosis?

It is important that anyone with RA who takes prednisone talks to their doctor about their risk of osteoporosis. However, women with RA should take special care to ask about being screened, especially if they already have osteoporosis.1

Osteoporosis screening is done by a process called dual-energy X-ray absorptiometry, or DEXA. You may need to take this test every year to check for changes in your bone density, especially if you are taking prednisone.4

Another reason to protect yourself from osteoporosis is the pain and balance issues that can commonly affect people with RA. Once osteoporosis sets in, bones can break as a result of a minor fall or other clumsy episodes that would have been harmless to people without bone loss.1

How is osteoporosis prevented or treated?

If you are diagnosed with osteoporosis, a few prescription drug treatments are available. Your doctor may also change or stop your use of prednisone, but do not suddenly stop taking it if you are worried about your osteoporosis risk.4

Preventing osteoporosis is a good idea, even if you do not take prednisone. Here are some tips to strengthen your bones:3

  • Eat a balanced diet with enough calcium and vitamin D. Calcium is found in healthy diet staples like yogurt, salmon, broccoli, cheese, and tofu. You can also find juices fortified with extra calcium or take a supplement. Talk to your doctor about how much calcium and vitamin D is right for you.
  • Get regular exercise. Walking, jogging, and strength training help build and keep bone density.
  • If you smoke, stop. If you drink more than 2 alcoholic drinks per day, cut down. Both of these can prevent your body from absorbing and using the calcium it needs.

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