Doctors Warn Steroid Users of Bone Disease

People taking steroids should exercise, watch their diet and get hormone replacement therapy to reduce the risk of osteoporosis, or “brittle-bone” disease, a national group of physicians and scientists said on Monday.
The American College of Rheumatology (ACR) released what it said were the first-ever national guidelines for the prevention and treatment of steroid-induced osteoporosis.

Corticosteroids are prescribed for the treatment of inflammatory diseases such as asthma, chronic lung disease, rheumatoid arthritis and inflammatory bowel disease.

“Approximately 20 million people in the U.S. have osteoporosis,” said Dr. Marc Hochberg, lead author of the guidelines. “We estimate that about 20 percent of these people have it because of the use of corticosteroid preparations.”

The ACR said patients taking corticosteroids should engage in weight-bearing exercises for up to an hour every day, limit alcohol consumption and not smoke. Corticosteroid patients should also consume 1.5 grams of calcium daily through diet or supplements and should also take a vitamin D supplement.

The ACR recommended hormone replacement therapy to counter the suppression of sex hormones due to steroid use.

“Our first recommendation in the guidelines is to use the lowest possible dose of steroids and if a patient is started on steroids that they be used for the shortest time possible,” said Dr. Nancy Lane of the University of California, San Francisco, one of the authors of the guidelines.

“If every physician who prescribed steroids immediately thought to reverse the things that steroids were going to do to bones, we wouldn’t have steroid-induced osteoporosis.”

The ACR also issued guidelines for specific bone density measurements involving the spine and neck to be used to monitor changes in bone mass. Osteoporosis increases the risk of bone fractures, particularly involving the spine, wrists and the hips, Hochberg said.

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