Orthopedics Osteoporosis What You Need to Know About Corticosteroid-Induced Osteoporosis Preventable and Treatable By Carol Eustice facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Carol Eustice Medically reviewed by Medically reviewed by Elizabeth Molina Ortiz, MD, MPH on April 06, 2020 linkedin Elizabeth I. Molina Ortiz, MD, is board-certified in family medicine. She is a primary care provider with Atrius Health in Boston and was the medical director of Charles River Community Health. Learn about our Medical Review Board Elizabeth Molina Ortiz, MD, MPH on April 06, 2020 Print Corticosteroids are one type of steroid medication. Sometimes the term "steroid" is used interchangeably with "corticosteroid." According to the American College of Rheumatology (ACR), more than 30 million Americans may be affected by diseases commonly treated with corticosteroids. Steroids such as prednisone are used as therapy for many inflammatory and autoimmune diseases, including: asthmarheumatoid arthritislupusinflammatory bowel disease They are also used to treat many allergic conditions. While steroids are generally effective in treating such ailments, they are also the most common cause of drug-induced osteoporosis. anncutting / RooM / Getty Images Corticosteroids and Bone Remodeling Corticosteroids affect calcium and bone metabolism in many ways: Steroids increase the natural rate of bone breakdownSteroids decrease bone formationSteroids decrease the amount of calcium absorbed by the intestineSteroids increase calcium excretion through the kidneys Steroids work directly on target tissues in bone to increase resorption and decrease formation. Their effects on calcium result in an indirect increase in destruction by triggering the parathyroid glands to increase the secretion of parathyroid hormone (PTH). This condition is known as secondary hyperparathyroidism. Elevated PTH levels result in increased bone breakdown, as the body attempts to rectify low circulating calcium levels by releasing calcium from the bones into the blood. Corticosteroids can also decrease the levels of the sex hormones: estrogen (in women)testosterone (in men) The resulting decreases are associated with increased bone loss. Corticosteroids also cause muscle weakness, which may lead to inactivity and additional bone loss. Patterns of Bone Loss There are two types of bone tissue: cortical and trabecular. Cortical bone forms the outer shell of bone and comprises 80% of the skeleton.Trabecular bone (the remaining 20%) is found inside the bone. Each bone in the skeleton contains both types of bone, but their proportions vary. Corticosteroids primarily cause bone loss in those areas of the skeleton that are rich in trabecular bone, such as the spine. Dose and Duration Bone loss occurs most rapidly in the first 6 to 12 months of therapy and is dependent on both: doseduration Other risk factors for osteoporosis may have an additive effect on bone loss, such as: agegenderunderlying disease For example, elderly men on steroids may experience even greater bone loss and risk for fracture than middle-aged men. The ACR estimates that without preventive measures, an estimated 25% of individuals on long-term corticosteroids will experience a fracture. The dose of corticosteroids is a strong predictor of fracture risk. While it is not clear whether there is a low-dose threshold below which bone loss does not occur, recent studies have found inhaled steroids to have little to no effect on bone density when administered in standard doses and apart from systemic steroids. Osteoporosis Management Steroid-induced osteoporosis is both preventable and treatable. According to the ACR, people on corticosteroids should have a bone mineral density test performed. This test will provide a baseline measurement from which to monitor subsequent changes in bone mass. The ACR also recommends a daily intake of 1,500 mg. calcium and 400-800 IU of vitamin D. Calcium and vitamin D can help maintain calcium balance and normal parathyroid hormone levels, and can even preserve bone mass in some patients on low-dose steroid therapy. Osteoporosis Drugs Osteoporosis medications approved by the FDA for corticosteroid-induced osteoporosis include: Actonel (Risedronate) for prevention and treatmentFosamax (Alendronate) for treatment In corticosteroid users, both drugs deliver beneficial effects on spine and hip bone mineral density and are associated with a decrease in spinal fractures. Estrogen therapy and Miacalcin (Calcitonin) may help preserve spinal bone mass in postmenopausal women on corticosteroids, but neither is FDA-approved for corticosteroid-induced osteoporosis. Lifestyle Modifications Eliminating smoking and alcohol are important in reducing the risk of steroid-induced osteoporosis.Physical activity and exercise can help to preserve bone and muscle mass while increasing muscle strength and reducing the risk of falls.Slip and fall prevention is of particular significance for elderly individuals and for those who have experienced steroid-induced muscle weakness. A Word From Verywell Osteoporosis prevention measures should begin early, ideally at the onset of corticosteroid therapy. Experts recommend using the lowest dose of steroid for the shortest period of time possible and, when feasible, inhaled or topical corticosteroids should be utilized. Was this page helpful? Thanks for your feedback! Dealing with joint pain can cause major disruptions to your day. Sign up and learn how to better take care of your body. Click below and just hit send! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Glucocorticoid-Induced Osteoporosis, NIH ORBD~NRC, 12/2000