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GLUCOCORTICOID-INDUCED
OSTEOPOROSIS |
Even if you are taking a glucocorticoid medication for inflammatory arthritis or some other condition, there is no reason that you should face the added problem of osteoporosis. To protect yourself, become familiar with osteoporosis and start taking calcium and vitamin D supplements . Talk with your doctor about additional medication options to protect your bones.
Fast Facts
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Anyone who is taking a glucocorticoid medication for more than 3 months
is at risk for osteoporosis.
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A daily regimen of calcium and vitamin D supplements (by taking calcium
supplements that have vitamin D added and one multivitamin per
day) can prevent problems.
Calcium alone is ineffective.
-
A rheumatologist can advise about other medication options.
What glucocorticoid-induced osteoporosis is
Glucocorticoid-induced osteoporosis is a form of osteoporosis that
is caused by taking glucocorticoid medications such as prednisone (Deltasone,
Orasone, etc.), prednisolone (Prelone), dexamethasone
(Decadron, Hexadrol), and cortisone (Cortone Acetate).
These medications are frequently used to help control many rheumatic diseases,
including rheumatoid arthritis,
systemic lupus erythematosus, and polymyalgia
rheumatica.
What causes glucocorticoid-induced osteoporosis
Glucocorticoid medications have both direct and indirect effects
on bone tissue that leads to bone loss. These medications have a direct negative effect on bone cells, resulting in a reduced rate of bone formation. In addition, they can interfere with the body's handling of calcium and affect levels of sex hormones, leading to increased bone loss.
Anyone who is taking glucocorticoid medications and has other risk
factors for osteoporosis is at especially high risk for developing
glucocorticoid-induced osteoporosis and suffering a fracture. Major
risk factors for osteoporosis are:
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Older age (starting in the mid-30s but accelerating
over 50 years of age)
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Non-Hispanic white and Asian ethnic background
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Small bone structure
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Family history of osteoporosis or osteoporosis-related
fracture in a parent or sibling
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Previous fracture following a low-level trauma, especially
after age 50
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Sex hormone deficiency, particularly estrogen deficiency,
both in women (e.g., menopause) and men.
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Anorexia nervosa
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Cigarette smoking
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Alcohol abuse
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Low dietary intake or absorption of calcium and vitamin
D
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Sedentary lifestyle or immobility
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Medications: excess thyroid hormone replacement; the
blood thinner heparin (Calciparine, Liquaemin, etc.);
certain anti-convulsant medications such as phenytoin
(Dilantin), etc.
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Certain diseases that affect bone, such as endocrine
disorders (hyperthyroidism, hyperparathyroidism, Cushing's
disease, etc.) and inflammatory arthritis (rheumatoid
arthritis,
ankylosing spondylitis, etc.).
Who gets glucocorticoid-induced osteoporosis
Anyone who needs to take glucocorticoid medications for more than 3
months is at risk of developing osteoporosis and fractures.
 |
Osteoporosis is a condition of weak bone caused by a loss of
bone
mass as well as a change in bone structure. The first picture
is
normal bone and the second shows osteoporotic bone. |
|
How glucocorticoid-induced osteoporosis is diagnosed
A simple test that measures the bone mineral density (BMD) at different
parts of your body, such as your spine and your hip, can help determine
if you have osteoporosis. Dual energy x-ray absorptiometry (DEXA) is the
best current test to measure BMD. The test is quick and painless; it is
similar to having an x-ray taken, but uses much less radiation. Even so,
pregnant women should not have this test done in order to avoid any risk
of damaging the developing fetus.
The results of the DEXA test are scored in comparison to the BMD of
young, healthy individuals, resulting in a measurement called a T-score.
If your T-score is –2.5 or lower, you are considered to have osteoporosis
and therefore at high risk for a fracture. T-scores between –1.0 and –2.5
are generally considered to show “osteopenia.” The risk of fractures is
generally lower in people with osteopenia when compared with those with
osteoporosis, but if bone loss continues, the risk for fracture increases.
How glucocorticoid-induced osteoporosis is treated
Anyone taking glucocorticoid medication, especially for more than 3 months, must take, at a minimum, 1000 to 1500 milligrams (mg) of calcium and 400 to 800 IU of vitamin D supplements on a daily basis. These supplements are useful in the management of glucocorticoid-induced osteoporosis. Several medications are available to treat osteoporosis (see “ How it’s treated” in the
patient information about osteoporosis) including glucocorticoid-induced osteoporosis. The decision to start additional medications will depend on your other risk factors, including your bone mineral density results. The bisphosphonates, alendronate (Fosamax) and risedronate (Actonel), are FDA approved both for the prevention and treatment of glucocorticoid-induced osteoporosis. Bisphosphonates should not be taken by women who might become pregnant at any time in the future. Teriparatide (Forteo) may be considered if you are at very high risk for an osteoporotic fracture.
Prevention
If you are apt to be taking glucocorticoid medications for more than a couple of weeks, you should start taking calcium and vitamin D supplements at the doses recommended above. Whenever possible, the dose and duration of glucocorticoid medication use should be minimized, if it is possible for your doctor to do so while keeping the disease you have under control. Other modifiable risk factors for osteoporosis should be minimized. Weight-bearing physical activity is encouraged. (See “Prevention” in the patient information about osteoporosis.) It also is important to help prevent trauma, which can increase the risk for fractures (See “Living with osteoporosis” in the patient information about osteoporosis.)
Bone mineral density testing is recommended for those likely to remain on long-term glucocorticoid medications.
Broader health impact of glucocorticoid-induced
osteoporosis
The most health-threatening consequence of glucocorticoid-induced osteoporosis is a fracture. Spine and hip fractures especially can lead to chronic pain, long-term disability and even death. The major goal in the management of glucocorticoid-induced osteoporosis is the prevention of fractures.
Points to Remember
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Regular weight-bearing exercise is an important part of prevention. |
- • A bone density test can measure changes in bone density during glucocorticoid treatment accurately.
- Bone loss from glucocorticoid treatment can be decreased by using calcium and vitamin D supplements.
The rheumatologist's role in the treatment
of glucocorticoid-induced osteoporosis
As specialists in musculoskeletal diseases, rheumatologists can help
to determine the cause of osteoporosis. They can provide and monitor
the best treatments for this condition.
To find a rheumatologist
For more information about rheumatologists, click
here.
For a listing of rheumatologists in your area, click
here.
For more information
The American College of Rheumatology has compiled this list to give you
a starting point for your own additional research. The ACR does not endorse
or maintain these Web sites, and is not responsible for any information
or claims provided on them. It is always best to talk with your rheumatologist
for more information and before making any decisions about your care.
National Osteoporosis Foundation
www.nof.org
National Institute of Health Osteoporosis and Related Bone Diseases Resource
Center
www.osteo.org
Updated June 2006
Written by Shreyasee Amin, MD, and reviewed by the American College of Rheumatology
Patient Education Task Force.
