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Prednisone Causes Osteoporosis

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Silently Destroying Bones

Corticosteroids, also called glucocorticoids, are powerful drugs for decreasing inflammation and modulating the immune system. They help control the symptoms of asthma, arthritis and other inflammatory and autoimmune disorders. These medications include cortisone, prednisone, beclomethasone and dexamethasone. Topical use of these medications as steroid creams can cause thinning skin, but it’s not associated with bone loss. Systemic use of corticosteroids, such as oral prednisone, however, causes osteoporosis and fractures. Decreasing inflammation with prednisone may help in managing the symptoms of autoimmune and inflammatory diseases, but it also weakens bones by speeding up bone breakdown and interfering with new bone formation.

Losing bone happens quietly, without any symptoms alerting people that it’s happening. The first sign that there’s a problem usually is when someone suddenly breaks a bone or gets a routine bone density scan (DEXA scan) that shows bone loss. Studies show that these drugs are so dangerous for bones that 30-50% of people taking them long-term suffer fractures. Taking these medications for only a few months increase fracture risk up to 75%.

Corticosteroids do more than just strip calcium from bones. Fractures can occur early in treatment before any meaningful bone loss has even occurred because these drugs damage the overall bone health and bone strength independent of calcium. The encouraging thing to know is this: as rapidly as fracture risk rises when taking glucocorticoids, the risk drops just as rapidly when therapy is stopped.

Even Small Amounts Put You at Risk

Doses as low as 2.5mg per day of prednisone for 6 months increase fracture risk of vertebral fracture, and higher doses create even greater risk. A study of nearly a half million patients found that those taking more than 7.5mg per day of prednisone (or the equivalent) doubled their risk of getting a hip fracture and nearly tripled their risk of a spinal fracture compared to people taking dosages less than 2.5mg per day.

What You Can Do

When it comes to medications, the goal should always be to take the lowest possible dose. This is especially true for glucocorticoids. These drugs play an important role in the management of many chronic diseases, and it is never safe to discontinue medications without guidance from your doctor. If you continue to take systemic corticosteroids, taking vitamin D3 and vitamin K2 (as MK4) can help protect your bones. Clinical trials with 45 mg per day of MK4 consistently demonstrate that MK4 may stop and reverse bone loss from corticosteroids.

References
Office of the Surgeon General US. Bone Health and Osteoporosis: A Report of the Surgeon General. 2004. [article]

Yun AJ, Lee PY. Maldaptation of the link between inflammation and bone turnover may be a key determinant of osteoporosis. Med Hypotheses. 2004;63(3):532-537. [article]

Weinstein RS. Glucocorticoid-induced osteoporosis and osteonecrosis. Endocrinol Metab Clin North Am. 2012;41(3):595-611. [article]

Van Staa TP, Laan RF, Barton IP, Cohen S, Reid DM, Cooper C. Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum. 2003;48(11):3224-3229. [article]

van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford). 2000;39(12):1383-1389.

Yonemura K, Fukasawa H, Fujigaki Y, Hishida A. Protective effect of vitamins K2 and D3 on prednisolone-induced loss of bone mineral density in the lumbar spine. Am J Kidney Dis. 2004;43(1):53-60. [article]

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