How do steroids affect bones?
Thanks to their ability to reduce inflammation and suppress the immune system, glucocorticoids (steroids) provide a useful and effective way of treating autoimmune diseases and conditions like asthma and arthritis. However, the way they impact a number of the body's key internal processes means that long-term use of steroids can significantly affect bone health, leading to a loss of bone density that increases the risk of fractures.
Steroids can affect your bones in several ways:
- Reduced bone formation: Steroids make it difficult for osteoblasts (the cells responsible for bone formation) to do their job. This results in a decrease in the amount of new bone that the body can make.
- Increased breakdown: At the same time, steroids boost the activity of osteoclasts (the cells involved in breaking down old bone tissue)
- Decreased access to calcium: Steroids reduce the amount of calcium that’s absorbed by the intestines and increase the amount that’s lost in the urine (pee), meaning there’s less available for bone rebuilding.
Together, these effects can lead to an overall decrease in bone density, known as osteopenia. Significant decreases in bone density are known as osteoporosis, a condition that can put you at greater risk of bone fractures with even minor injuries.
Bone is one of the tissues most affected by steroids and the problems it causes can be serious at any age.
Why does this happen?
The effect of steroids on the bones is closely linked with their ability to reduce inflammation. While reducing inflammation and suppressing the immune system, steroids radically affect the action of the hormones that regulate calcium absorption and bone health. This includes the actions of important natural hormones like cortisol, estrogen, and vitamin D. These changes reduce the body’s ability to make bone tissue, leading to thinner bones that are more likely to fracture.
Top tips for managing your bone health
Here are six practical things you can do to minimize tissue loss and strengthen your bones:
1. Make sure you’re getting enough calcium and Vitamin D:
- Calcium: Aim for an adequate calcium intake in your diet or supplements. Adults typically need about 1,000 to 1,200 mg of calcium per day. Dairy products, leafy greens, and calcium-fortified foods are good sources.
- Vitamin D: Vitamin D is essential for calcium absorption so make sure you’re getting enough. The amount you need varies depending on your specific health conditions and local guidelines but is thought to be around 800 to 1,000 IU per day. Sun exposure, oily fish, and fortified foods can help, along with supplements if necessary.
2. Try to do regular weight-bearing exercise:
Activities like walking, jogging, dancing, or weight training can help build and maintain bone density. Aim for at least 30 minutes of weight-bearing exercise most days of the week.
3. Monitor your bone density:
Discuss the need for regular bone density scans (DEXA scans) with your doctor. These can help monitor the health of your bones over time and are especially important if you are on a long-term steroid treatment plan. See the section below on how often you should have a bone mineral density (DEXA) scan.
4. Avoid smoking and limit alcohol intake:
Smoking and heavy alcohol consumption can further weaken the structure of your bones.
5. Consider medication to protect bone health:
In some cases, your doctor might recommend medications to help protect against bone loss. Bisphosphonates, for example, are drugs that can help slow down bone breakdown and can help to improve your bone mineral density.
6. Regular medical check-ups:
Regular consultations with your doctor are crucial. Your medications may need adjustment based on how they’re affecting your bone health.
What is a bone mineral density (DEXA) scan?
Bone is one of the tissues most affected by steroids, and the problems it causes can be serious for patients of any age. Fortunately, bone mineral density scans (also known as DEXA scans) are excellent at measuring bone density with accuracy. Similar to a CT (computed tomographic) scan, they help clinicians keep an eye on sites like the lower back, hips, and wrists that are vulnerable to fracture. Regular bone mineral density studies are absolutely critical for managing your overall health while on steroids.
How often should I have a bone mineral density (DEXA) scan?
Guidelines vary depending on your unique health situation. Post-menopausal women, who are at risk of osteoporosis even if they are NOT on steroids, should make sure that they receive a bone mineral density scan within 2-3 years of menopause and then every two years afterward. For post-menopausal women who also take high doses of steroids, scan frequency should increase to once a year.
Other patients on steroids, or just starting a course of steroids, should have a baseline bone mineral density scan performed (preferably) at the very start of their steroid treatment and then every year afterward while steroid treatment continues. This is particularly key for those over 50 but may also apply to some younger patients.
Estimating your risk of a bone fracture
If you’re aged between 39 and 91, a simple online tool known as the FRAX® can help your doctor work out your risk of getting a bone fracture over the next ten years. Your risk varies according to your age, sex, bone mineral density in the hip (assessed accurately by a bone mineral density study), as well as the fact you are taking steroids.
Understanding your fracture risk over the next ten years supports informed decision making about whether or not to start bone-strengthening medications such as bisphosphonates. It is well worth asking your doctor about using the FRAX® tool to estimate your risk of fracture so that you can take the appropriate steps to protect yourself.
The bottom line
Steroids are highly effective for managing many inflammatory and autoimmune conditions. However, their impact on bone health can be significant. By taking steps to manage this side effect, such as getting enough of the right nutrients, a little weight-bearing exercise, and regular monitoring of bone health with your doctor (including DEXA scans and use of the FRAX® tool), you can help maintain your bone density and reduce your risk of fractures.
Remember, always consult your doctor before making any changes to your medication or lifestyle to ensure the best care for your specific health needs.