Corticosteroids are categorized as steroid medications that has been used in various conditions but capable of causing osteoporosis in some individuals.
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Close look on corticosteroids
Various diseases are managed with corticosteroids. One of the commonly used steroids, specifically prednisone is utilized as therapy for various autoimmune and inflammatory diseases such as lupus, asthma, rheumatoid arthritis and inflammatory bowel disease.
They are also used to manage various allergic conditions. Even though they are effective in treating these ailments, they are also the common cause of drug-induced osteoporosis.
Connection between corticosteroids and bone remodeling
It is important to note that corticosteroids can influence the calcium and bone metabolism in various ways such as the following:
- Increase the elimination of calcium via the kidneys
- Reduce the quantity of calcium being taken up by the intestines
These 2 factors work together to trigger a deterioration in the available ionized calcium concentration. This initiates the parathyroid glands to amplify the release of parathyroid hormone, resulting to a condition called as secondary hyperparathyroidism. The high levels can result to heightened breakdown of bone as the body tries to rectify the low circulating level of calcium by releasing calcium from the bones into the blood.
Corticosteroids can also reduce the levels of sex hormones (estrogen and testosterone). The reduction is linked to increased bone loss. The medications can also lead to muscular weakness that can lead to inactivity and further bone loss. In addition, a significant effect of corticosteroids is that they can affect the bone directly by disrupting with bone formation activity, thus increasing the risk for osteoporosis.
What are the patterns of bone loss?
There are 2 types of bone tissue – cortical and trabecular. It is important to note that every bone in the skeleton is comprised of both types of bone but the proportions tend to vary. Corticosteroids mainly cause bone loss in areas that are rich in trabecular bone such as the spine.
Duration and dose of corticosteroids
Bone loss that leads to osteoporosis rapidly occur in the initial 6-12 months of therapy and depends on the duration and dosage. Other potential risk factors for osteoporosis that can lead to further bone loss include gender, age and underlying disease.
Management of osteoporosis
Osteoporosis that is linked to corticosteroids is both treatable and preventable. Always bear in mind that individuals who use corticosteroids must undergo a bone mineral density test. The test provides a baseline measurement on which to monitor future changes in the bone mass.
It is recommended to stick with a daily intake of 1500 mg of calcium and 400-800 IU of vitamin D. Take note that calcium and vitamin D can maintain the calcium balance and normal levels of the parathyroid hormone, thus preserving the bone mass in some individuals under low-dose steroid therapy.