Ask An Expert: Steroids and Bone Loss

Content provided by the Faculty of the Harvard Medical School

Ask An Expert: Steroids and Bone Loss

Question:

Will long-term use of a steroid medicine cause excessive bone loss?

Answer:

Corticosteroids (often called glucocorticoids or steroids) are very powerful medications used to treat many different medical problems and illnesses, from allergic reactions to inflammatory diseases such as lupus and asthma. Unfortunately, taking these medications for more than a few months, even at relatively low doses, can indeed lead to significant loss of bone, or osteoporosis. Even using a high-dose corticosteroid inhaler (often prescribed for asthma) has been shown to sometimes lead to thinning of bones.

However, corticosteroids are often life-saving medicines and may need to be taken for many years. It is important never to stop them without discussing it with your doctor. So prevention of osteoporosis in people who must take these drugs is very important. What can you do to try and prevent this complication? Most people need adequate calcium in their diet (1,500-2,000 mg per day) and some form of vitamin D replacement. Weight-bearing exercise (such as walking or running) helps counteract the bone loss and is recommended. In addition, you should stop smoking if you smoke, and cut back on drinking alcohol if you drink.

There are also prescription medications that might help prevent the development of thin bones in people taking corticosteroids. Clinical trials have shown that medications known as bisphosphonates, which include drugs like Fosamax and Actonel, are effective in preventing the development of thin bones from corticosteroids. Another drug called calcitonin is an alternative for patients to prevent thin bones.

People on chronic corticosteroids should discuss these issues with their doctor, consider getting bone density tests to monitor for thin bones and to measure their response to preventive therapy, and make sure they and their doctors are doing everything possible to prevent (or treat) osteoporosis.

Diana Post, M.D., is an assistant professor of medicine at Harvard Medical School and a member of the Department of Medicine at Brigham and Women's Hospital.

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Last updated:	January 24, 2007

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