Glucocorticoid-Induced Osteoporosis Common, May Have Catastrophic Consequences In Aging Population And In Patients With Rheumatic Disease,

Patients who receive glucocorticoids should be counseled about adequate intake of calcium and vitamin D, weight-bearing exercise, and avoidance of smoking and excessive alcohol intake. Pharmacologic treatment is strongly recommended for anyone who has had a fracture, and for patients who are at least age 40 if, according to FRAX, the risk of major osteoporotic fracture is ≥20%, or the risk of hip fracture is at least 3%. Pharmacologic treatment is also recommended for men who are ages ≥50, and for postmenopausal women, who are on glucocorticoids and have a BMD T score of −2.5 or less (indicating osteoporosis) at either the spine or the femoral neck. https://www.medpagetoday.com/endocrinology/osteoporosis/77385 Cortisol also causes this, even in the young active folks. One of the tragic medical conditions we've seen this past 6 years while being involved in orthopedic stem cell work is young healthy patients that develop osteonecrosis (ON also known as avascular necrosis) of the hip after taking oral steroids. As an example, we just reviewed stem cell procedure candidacy for a young man who was given high dose oral steroids for an upper respiratory infection and as a result developed osteonecrosis. Luckily this was one of the few patients who contacted us for an AVN stem cell treatment early, while he was firmly in stage 1-where the success rate of a stem cell reimplant to treat osteonecrosis is still very high. As a result of yesterday's reminder of this very dire societal problem, I decided to focus the blog this morning on high dose oral steroids and ON. Osteonecrosis is a disease where the bone (usually in one area, sometimes in many) begins to die off and will often rapidly collapse. This problem occurs most often in the hip. In many patients frequent causes are alcoholism and malnutrition, but the most common easily preventable cause of osteonecrosis is high dose oral steroids. Oral steroids like Prednisone are powerful anti-inflammatories that can reduce swelling in serious medical conditions like asthma, however they are also given to patients for much less serious conditions such as a simple upper respiratory infection or a flare up of sciatica. Your body uses steroid anti-inflammatory hormones everyday, so your body is used to seeing a certain amount of these compounds. The problem is that while oral steroids can reduce swelling, they are given in such high doses that they can cause some of the cells that help to maintain bone to die off or become stunned. Not everyone or even most people that take these powerful drugs will get osteonecrosis. How much does taking oral steroids raise your osteonecrosis risk? One recent study in Japan calculated that your risk of getting osteonecrosis was 20 times higher by taking oral steroids (OR=20.3). Since the overall risk of spontaneously being diagnosed with ON is small, 20 times a small number is still a relatively small number. However, to put this risk in perspective, the anti-inflammatory Vioxx was taken off the market by the FDA because it roughly doubled the risk of sudden death due to a heart attack. Your odds of getting a heart attack with Vioxx are 10 times less than your risk of having your hip turn to mush with oral steroids. What's interesting is that we have known for awhile (1987) that oral steroid dose is directly related to the amount of ostenecrosis that is caused by the drug-the higher the dose, the more ON you see as a side effect. This same effect has been seen by others. As a result, some authors have argued for lower pulsed doses of steroids (meaning giving the patient a lower dose with "drug holidays" in-between doses). https://www.regenexx.com/blog/areas-treated/hip/oral-steroids-and-the-tragedy-of-osteonecrosisavascular-necrosis/