If you suffer from rheumatoid arthritis your doctor may prescribe you a glucocorticoid medication to decrease inflammation and control your symptoms.

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If you suffer from any number of inflammatory diseases, including rheumatoid arthritis, chronic obstructive pulmonary disorder (COPD), inflammatory bowel disease, or many others, your doctor may prescribe you a glucocorticoid medication to decrease inflammation and control your symptoms. But prolonged use of these drugs can come with significant risk. Many people are at risk for osteoporosis, one of the major glucocorticoids side effects, without even knowing it.

What are glucocorticoids and why are they used?

Glucocorticoids are produced naturally in the body. They are a class of steroid hormones that are responsible for turning down the inflammatory response of the immune system when it is overactive.

Often administered as drug therapy for people with chronic inflammation, these drugs include prednisone, dexamethasone, hydrocortisone, and more. They are used to suppress the immune system’s inflammatory response. In some cases, glucocorticoids are prescribed for short-term use to treat a flare-up of symptoms. The danger occurs, however, when glucocorticoid use becomes prolonged; therapy with these types of drugs can often persist for many months or even years.[1]

Glucocorticoid-induced osteoporosis

Researchers know that glucocorticoids cause a decreased production of osteoblasts (cells that form bone) and an increased activity of osteoclasts (cells that break down bone).[1,2] This means that high levels of glucocorticoid activity ultimately switch off bone formation and promote bone breakdown, which results in reduced bone mass and weaker bones.[3]

Glucocorticoid treatment that lasts for three or more months is known to be detrimental to bone health; oral glucocorticoid therapy is the leading cause of secondary osteoporosis, which means cases of low bone mineral density and increased risk for fracture that are caused by something other than the natural aging process.[1,2]

Bone loss occurs quite rapidly within the first year of glucocorticoid use, at a rate of 6% to 12%. The risk of fractures also increases significantly; doses as low as 2.5 mg per day of prednisone can cause fractures.[1] One study showed that every 0.5 mg/kg increase in glucocorticoid dose doubled the risk for vertebral fractures.[4]

Glucocorticoids side effects on bone health are quite serious, yet studies show that people receiving these drugs don’t get the help they need to avoid osteoporosis. One review found that less than 40% of people who are on long-term ­glucocorticoids are receiving bone mineral density testing or osteoporosis treatment and prevention tools.[1] Another found that interventions to improve the treatment and management of glucocorticoid-induced osteoporosis remain largely ineffective.[5] So what can you do to reduce your risk?

Keeping your bones healthy

Most importantly, try to avoid using these medications in the first place. There are a number of all-natural therapies that you can try first to help relieve your symptoms without them. Browse our extensive collection of resources on natural strategies for treating inflammatory conditions. Get started with some of the following blogs:

• 7 Tips for Finding the Right IBD Diet
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If you and your doctor determine that glucocorticoid therapy is the best option for you, be sure to take preventative measures to keep your bones as healthy as possible. Make sure to monitor your bone mineral density scores regularly to make sure you aren’t heading towards osteoporosis. If you see changes in your scores while using the medication, take measures to boost your bone density. Sufficient calcium levels are important, but even more important may be maintaining optimum levels of vitamin D and magnesium.

There are many alternatives to glucocorticoids and it’s important to avoid them if you can. Start by embracing an anti-inflammatory diet (learn more here) and then explore the NHA website for remedies that are specific to your condition. If you need help, use the integrative physician directory to find a healthcare provider near you that can help you treat your inflammatory condition successfully and without harm.

Share your experience

Have you ever experience glucocorticoid-induced osteoporosis? What are your favorite osteoporosis prevention strategies? Share your tips in the comments section below.

[1] J Popul Ther Clin Pharmacol. 2014;21(3):e486-504.

[2] Best Pract Res Clin Endocrinol Metab. 2014 Dec;28(6):911-35.

[3] Clin Med. 2012 Jun;12(3):261-5.

[4] J Bone Miner Res. 2015 Mar 19. [Epub ahead of print]

[5] Semin Arthritis Rheum. 2015 Apr;44(5):483-488.