Chronic Steroid Side Effects: Osteoporosis

By | January 21, 2012

Osteoporosis leading to hip fracture is a major cause of morbidity and mortality among the elderly.

While not commonly seen in the doses used in the treatment of chronic pain, significant osteoporosis can occur with as little as 30 mg of hydrocortisone or 7.5 mg of prednisolone everyday for 3 months.  Steroid induced osteoporosis is most severe in the axial spine, but also affects the long bones.  Alternate day dosing, which is effective in preventing many chronic steroid side effects does not appear to be effective in preventing osteoporosis. Possible mechanisms for producing the osteoporosis include increased bone reabsorption, decrease osteoblastic activity, decreased absorption of calcium from the GI tract, increased excretion of calcium in the urine and decreased production of sex hormones, which would otherwise have a protective effect.  Besides trying to hold the dose of steroids down, we at Schlesinger Pain Centers work with your primary care physicians to assure that all patients on chronic steroid therapy have annual bone density measurements as well as blood tests to assess the adequacy of serum calcium, vitamin D, calcitonin and parathyroid hormone.

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