Osteoporosis. Prednisone. What Is The Risk?

prednisone

Sometimes the medications you use to treat one health problem can increase your risk of prednisone or another health problem. This is exactly what can happen when you take prednisone. Long-term use of prednisone is linked with an increased risk of osteoporosis. [1]

Let’s take a look at how the use of prednisone can lead to osteoporosis and the best ways to prevent that from happening.

What is prednisone?

Prednisone is a steroid, a type of corticosteroid, that is usually prescribed to manage inflammation and immune system issues. Women have often prescribed it for relief from joint pains caused due to osteoarthritis. [2]

The irony is while this drug can reduce inflammation in the joints and can reduce joint pain, it also can make the joint weaker by causing osteoporosis. 

Steroids like prednisone may also be prescribed for the allergic reactions, like redness or swelling that occur due to an allergic reaction. 

For example, dust or pollen can cause sneezing, or a skin reaction, or an asthma attack. It can help to relieve the symptoms of these allergic reactions by suppressing or modifying the reaction of the immune cells. [3]

Similarly, autoimmune disorders may occur when the immune cells fail to recognize the healthy tissues of the body as its own and attack and destroy them.

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Lupus, rheumatoid arthritis, multiple sclerosis, and inflammatory bowel diseases are common autoimmune disorders caused by abnormal immune system response. Regular use of prednisone may be recommended in those cases to suppress the immunity in order to protect the healthy tissues and prevent damage. [4]

You may see benefits of using this to limit the extent and severity of a reaction, but you need to be careful while using prednisone because it does have side effects including affecting bone health. [5]

Why do we need to be more cautious about the use of prednisone? 

Osteoporosis is the loss of bone density. It can be caused by a deficiency of calcium and vitamin D – both of which play a key role in bone formation. Lack of these nutrients can inhibit the formation of new bone cells and worsen the rate of degeneration of the old bone cells. This makes the bones weak and porous resulting in osteoporosis.

If your bones are weak, they may be unable to withstand pressure or strain and may crack or fracture even after minor trauma like a bump or fall. 

Your risk of osteoporosis is higher if you are menopausal or postmenopausal because the production of a female reproductive hormone called estrogen declines during these phases.

The lack of estrogen makes it harder for your body to absorb calcium and vitamin D that your body needs to sustain bone health. It increases the risk of osteoporosis by affecting calcium and vitamin-D metabolism.

What is the effect of prednisone on your bones?

Steroid medications like prednisone can have a major effect on the metabolism of calcium, and vitamin D. The long-term use of prednisone can lead to bone loss resulting in osteoporosis and an increased risk of fractures (broken or cracked bones). 

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Research studies have revealed that glucocorticoids like this medicine can modify the functions of osteoblasts – remember those?  Osteoblasts spur the growth of bone cells.

This means that the long-term use of prednisone can affect the ability of osteoblasts to form new bone cells. It can also reduce the total number of osteoblasts in the body that are working to generate new bone cells.  

It can also affect the cell differentiation processes of osteoblasts. This means the newly formed bone cells may not be mature enough or well-formed enough to support bone health.

These changes in the osteoblastic activities make the bones weaker resulting in the development of osteoporosis. 

Additionally, prednisone may also inhibit new bone formation. This occurs due to the decrease in the number of existing osteoblasts as well as the destruction of mature osteoblasts. 

That’s not all! When women use of this medicine for a long duration, the process of osteoclastogenesis is stimulated. Osteoclastogenesis refers to the processes involved in the formation of new osteoclasts, which are the cells that break down the bone tissues.

This means osteoclastogenesis can increase the rate of bone loss, accelerating the pathogenesis of osteoporosis. [6]

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This medicine is also found to be responsible for the stimulation of bone resorption, the transfer of calcium from bone tissues into the blood. This triggers initial bone loss when people start using this drug. [7]

Eventually, these abnormal changes in the processes involved in bone formation, bone resorption, and bone breakdown affect bone remodeling causing osteoporosis

What can women do to avoid prednisone-induced osteoporosis?

  • Take the minimum required dose of prednisone for the shortest possible period of time [8] [9]
  • Increase your intake of calcium and vitamin D-rich foods
  • Stop smoking
  • Limit alcohol intake
  • Exercise regularly 
  • Consider using calcium and vitamin D supplements if you need to use prednisone over several months
  • Take safety precautions to avoid falls

Conclusion

Prednisone is an effective medication that can control inflammation and immune system reactions in an effective way. It can provide relief to patients who suffer from allergies and autoimmune disorders.

However, people advised using this medicine need to be careful about the effect of prednisone on their bone health. 

If a person needs to use it regularly, they must take steps to protect their bones from the impact of this drug.

Regular bone mineral density tests and bone scans are highly recommended to help people assess their bone health so that they can adopt appropriate measures to prevent the development of osteoporosis. 

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601727/
  2. https://www.ncbi.nlm.nih.gov/books/NBK534809/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765115/
  4. https://pubmed.ncbi.nlm.nih.gov/420618/
  5. https://jaoa.org/article.aspx?articleid=2093164
  6.  https://pubmed.ncbi.nlm.nih.gov/12819474/
  7. https://www.ncbi.nlm.nih.gov/pubmed/15746991
  8. https://www.health.ny.gov/publications/1985/index.htm
  9. https://annals.org/aim/article-abstract/702120/recovery-from-steroid-induced-osteoporosis

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