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Prednisone & bone damage- how much for how long?

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Posted 6/20/2011 11:04 PM (GMT 0)
Just curious - does anyone know how long and at how high of a dose it takes before prednisone starts to affect your bones? I had a bone scan done about 3 month into pred (Jan 2010) and I was told that I "have the bones of a 20 year old". I continued on pred until Dec 2010, and am now back on again. Last time I asked my Dr about getting another bone scan, she said that pred would not affect my bones that quickly, and there was no need for a second scan.

I can't find any info on this anywhere. Does anyone have any ideas/experiences?
Posted 6/20/2011 11:35 PM (GMT 0)
I don't know the answer to your question but I just wanted to say that I don't think a second bone scan is a bad idea, especially if you're concerned. I had a scan at the beginning of pred and I am curious to have a follow up but I haven't suggested it to my doctor. I have a feeling she would react the same way yours did.

Did you have a bone density scan?

My original results average, not great.
Posted 6/20/2011 11:41 PM (GMT 0)
Yes, I had a bone density scan. I asked my Dr about two months ago, and wasn't on pred at the time....I just worry because so many people say they have bone problems from pred. Also, at the time of my original scan, I was working out regularly playing soccer 2x a week, kickboxing and strength training. Now I am doing nothing. Every time I try to go back to those things, I am wiped for 2 days. :(

I am just not sure how fast the bones deteriorate.
Posted 6/21/2011 12:39 AM (GMT 0)
Found this -

Osteoporosis (thinning of the bones) particularly in smokers, postmenopausal women, the elderly, those who are underweight or immobile, and patients with diabetes or lung problems. Osteoporosis may result in fractures of the spine, ribs or hip joint with minimal trauma. These occur after the first year in 10-20% of patients treated with more than 7.5mg prednisone daily. It is estimated that up to 50% of patients on long term oral corticosteroids will develop bone fractures.
Posted 6/21/2011 12:42 AM (GMT 0)
And this - (Note that it says that most bone loss occurs in the first few months)

Prevention of osteoporosis

Specific measures to reduce the chance of steroid-induced osteoporosis should be considered for patients that have taken or are expected to take 10 mg or more of prednisone or prednisolone each day for a period of three months or longer.

A DEXA bone scan measures bone density. Bone density gives an indication of the risk of fracture due to bone loss. Arrange to have a scan as you start systemic steroids, and it should be repeated every year or as recommended by your physician.

Preventative treatment includes the following medications:

Calcium tablets 500 to 1000 mg per day
Vitamin D in various forms including monthly cholecalciferol 50,000 units (1.25 mg)
Oestrogen i.e. hormone replacement tablets in females that have had early menopause
Bisphosphonates (alendronate, etidronate); these are prescribed for patients at especially high risk of fracture.

Treatment is most effective when started at the same time as the steroids, as most bone loss occurs within the first few months. This is most important for people taking more than 7.5mg of prednisone (or the equivalent dose of another oral corticosteroid) for three months or longer.

If you smoke, stop. Consume minimal alcohol. Take regular weight bearing exercise e.g. walking for 30 to 60 minutes each day.
Posted 6/21/2011 1:10 AM (GMT 0)
I don't know the answer, but I do know that my doctors were adamant about me getting off of Prednisone. I had been on it 3 times over the past five years at 40 mg tapers that took about a month each. It always worked to end my UC flares. Then I had a severe flare last September where I was on my usual taper for about a month with no improvement in my flare. Also had 60 mg of I.V. Solumedrol in the ER a couple of times for this same flare. This also didn't work. Eventually I was admitted to the hospital and was on 120 mg of I.V. Solumedrol (maybe the equivalent of 60-80 mg of Prednisone???) for another week with no improvement. Every GI there said that I needed to get off the stuff as they were worried about the effects of these high doses of steroids on my joints years down the line. I was a little surprised as I hadn't been on steroids that long in the grand scheme of things... a total of six to seven months in my life including all the various doses and tapers. They basically said try Remicade or have surgery. No more Prednisone. And this wasn't one GI's opinion. During my hospital stay, I saw 6 different doctors and they all said the same thing. As I have mentioned in other posts, I tried Remicade and had bad side effects. I had a permanent ileostomy a month later. I spent a few months tapering off the high doses of steroids during and after surgery, but it feels good to know I won't have to take it anymore. Still worry about osteoporosis down the line. I am super active and the last thing I want are brittle bones. The drugs to rebuild bones don't sound that great either.
Posted 6/21/2011 9:16 AM (GMT 0)
Hi there

I don't know the answer to your question as we all respond differently to pred. I have had UC over thirty years and have lost count of the number of pred tapers I've done in that time including hospital stays with IV hydrocortisone. I've had side effects like everyone else but my bone density scan last year showed no deterioration at all and that is after very long term high usage. It's probably pretty much like everything else regarding meds the bad side effects warrant discussion but people are less like to report they've been absolutely fine. I have taken calcium supplements occasionally but certainly not with every course of pred I've taken.
Posted 6/21/2011 11:41 AM (GMT 0)
mom2panda,

Not sure about the statistics., however I can tell you that since my 2 rounds of prednisone, my bone density scan has shown significiant deterioration :(

I had to beg my Gyno to give me script for the bone scan because she didn't see the connection between the prednisone and bone loss (what an idiot!).

My suggestion is you get the bone density scan.

Posted 6/21/2011 1:47 PM (GMT 0)
There's no way to predict bone loss from pred patient to pred patient. The best course to follow is to get off the drug, especially if you are already showing bone loss. There are other horrible bone disorders, AVN, that can also occur with even short courses of prednisone. I think you know that this drug should not be considered maintenance medication, research indicates that if you cannot successfully wean off prednisone within 4 months that one is effectively prednisone dependent and other regimes for remission need to be followed.

Sue
Posted 6/21/2011 3:49 PM (GMT 0)
I had osteoporosis before I was ever dx with UC. After 2 years of Evista and 3.5 months of pred, I got another bone density test. The Evista had done it's job and I only have osteopenia (still not great, but much better than before). I don't think the pred caused much damage. Of course, I didn't have any of the bad side effects from the pred (just increased appetite for a couple of weeks).
Posted 6/21/2011 9:21 PM (GMT 0)
I don't know if this will help but perhaps.
I am now 65. I have no osteoporosis. I have had UC since I was 16. I was on steroids for quite a long time. The first few years. I got heavy doses, tapering off, and then heavy doses again. I had a hard time going into even mild remission for a while. By college, I was on a low dose but not all the time. In fact I was on and off low doses of prednisone well into my 20s.
Fortunately by my mid thirties, I stopped needing to do that. I still had flares but the closer I got to menopause, the milder the flare.
Now at 65, I have not used steroids since my late 20s.
I do have what I call lumpy wrists and ankles. It looks like I had a broken bone but I never did. I suspect they are the results of the steroids along with some stretch marks from moon face.
But overall my bones remain strong.
Posted 6/21/2011 10:02 PM (GMT 0)
Thanks everyone.

I expect this will be my last time on prednisone. I am waiting for my taper schedule from the Dr. He wants me to do one more double dose of the Remi (end of July) before we make the final decision about surgery. I suppose that if the Remi doesn't work, then I may stay on it longer...not sure.

Either way, I may ask my Doctor about the scan again.
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