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Steroid Injection

What are steroid medications?

Steroid medications, known as corticosteroids, include medications like prednisone and cortisone. Steroids can be administered through several routes but are usually taken by mouth or inhaler. They are therapeutically important in treating different disease conditions such as asthma, rheumatoid arthritis, lupus, inflammatory bowel diseases, and multiple sclerosis. Therefore, it is necessary to discuss with your physician regarding steroid use and follow their recommendations to protect and promote strong bones.

What are the effects of steroids on bone?

Steroids affect the metabolism of calcium, vitamin D, and bone resulting in bone loss, osteoporosis, and fractures. High-dose steroids can cause bone loss quite rapidly, but not in all patients. The rate of bone loss with steroids varies according to the steroid dose and the underlying disease. Further, some patients are genetically susceptible to the effects of steroid medications.

When do steroid medications cause bone loss?

Rapid bone loss will be observed in the first 6 months after starting oral steroid medications. After chronic use of steroids for 12 months bone loss occurs slowly. Inhaled steroids are less likely to cause bone loss compared to oral steroid medications. Nevertheless, inhaled steroids may also cause bone loss if given at higher doses. Steroids used for only a few days or applied topically on the skin are not associated with bone loss.

Do steroids increase the risk for fractures?

Steroids increase the risk for fractures, especially in the spine and ribs. Oral steroid prednisone (5mg or more) taken daily for more than three months is considered a risk for fracture. As the dose increases the fracture risk also increases. A patient taking steroid medications has a spine fracture risk 2x greater than a person not on steroids. Postmenopausal women who are on steroids for more than six months have the greatest risk of bone loss. Among postmenopausal women taking steroid medications one in every three are at risk for a spine fracture.

What will happen to the risk for fracture after taking steroid medication?

Though steroids increase the risk for fractures, you should not change the medication without consulting your physician. Your physician will recommend you stop taking steroid medications, if it is expected that the fracture risk will reduce after the medication is discontinued.

How do I know if I am at risk for osteoporosis?

It is necessary to review your risk factors for determining the risk of osteoporosis. Discuss with your physician regarding risk factors and bone mineral density test (BMD test) findings. It is advised to get a BMD test before initiating steroid therapy for more than three months.

Are there any drugs to protect bone during steroid therapy?

Many drugs, approved by the U.S. Food and Drug Administration (FDA), are available to prevent bone loss, and to reduce the risk of osteoporosis related fractures for patients on chronic steroid therapy.

How to treat or prevent osteoporosis?

Prevention and treatment of osteoporosis includes:

  • Eating a nutritious diet rich in fruits and vegetables
  • Taking foods and supplements containing calcium and vitamin D
  • Being physically active every day to the extent of your abilities
  • Quitting smoking
  • Limiting the amount of alcohol intake
  • Taking safety precautions to avoid falls
  • If you are taking steroid drugs regularly, lifestyle modifications alone are not enough to control osteoporosis. You may require an osteoporosis medication to stop bone loss or prevent fractures. Your physician decides the need for an osteoporosis medication based on a number of factors including your BMD test results, the expected dose and duration of steroid medications, and the evaluation of other risk factors for osteoporosis.

    • Orthopedic Physician Associates
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