Glucocorticoid-induced osteoporosis (GIO) is a condition in which people who take medicines called glucocorticoids develop osteoporosis—weakening of the bones. Osteoporosis increases the risk of broken bones (fractures).
Glucocorticoids are synthetic (manufactured) hormones also known as steroids. They include medicines such as prednisone, cortisone, hydrocortisone, and dexamethasone.
Common conditions treated with glucocorticoids include:
Glucocorticoids can be taken as a pill (by mouth), an injection under the skin or in a vein, a nasal spray or inhaler, or even as a skin ointment or cream. Glucocorticoids given by mouth, by vein, or by skin injection are most likely to cause osteoporosis.
Normally, your body continuously removes old bone and replaces it with new bone. However, glucocorticoids can increase the breakdown of bone and decrease the formation of new bone. This can cause your bones to weaken. Weak bones can break easily when you have a minor fall (called a fragility fracture). Some people break bones for no reason at all. Bone fractures can be serious and painful. They can affect your ability to move, walk, and care for yourself.
Glucocorticoids start to weaken your bones during the first 3 months of use. The rate of bone loss is greatest within the first 6 months of treatment but continues as long as you take glucocorticoids. The higher your dose, the greater your risk of GIO. But even low doses can cause GIO over time. Therefore, experts recommend that doctors prescribe the smallest possible dose for the shortest period of time.
A bone mineral density test (also called a DXA test) measures the strength of your bones. This simple, painless test uses low-dose x-rays to help predict your chances of having a fracture. Your doctor also may check your spine for fractures using x-rays or an MRI (magnetic resonance imaging) test.
If you’ll be taking glucocorticoids for 3 months or longer, you can lower your risk of GIO by following these steps:
Experts also suggest taking calcium (1000-1200 mgs daily) and vitamin D (1000-2000 IU daily) supplements, even if you’re taking glucocorticoids for less than 3 months. Your doctor can tell you how much to take. Your doctor also may check your risk of falling and provide advice about how to prevent falls. People who are especially at risk for osteoporosis will need medicine.
Your doctor will review your medical history, current condition, and glucocorticoid dose to determine your risk. Experts recommend bone-protective medicine for certain groups who are taking glucocorticoids for at least 3 months:
Three types of medicines are available. Your doctor will prescribe the type of medicine that’s best for you.
Ask your doctor if you need a DXA test and how much calcium and vitamin D you should take. If you need medicine to protect your bones, talk with your doctor about how long you should take it, what side effects you might have, and any other questions that concern you.