True, in a round about way
The 30 million Americans with arthritis, asthma, bowel and other problems who take steroid drugs at high doses or for six months or longer are at risk of osteoporosis and bone fractures, doctors at a national meeting reported Wednesday.
The findings, from two studies presented at the American College of Rheumatology's annual meeting in Washington, D.C., underscore for steroid drug users the importance of getting adequate vitamin D and calcium. They also indicate the need to periodically undergo tests to detect bone loss, experts said.
"Virtually anyone who uses these drugs long-term is at risk" of osteoporosis, said Dr. Philip Sambrook, an international expert on steroid-induced osteoporosis.
Patients also should talk with their doctors about bone measurements when they begin long-term use of steroids, he said. "They shouldn't wait six months," said Sambrook, professor of rheumatology at the University of Sydney in Australia.
Osteoporosis, a progressive bone disease, affects some 25 million Americans, 80 percent of them women. It causes hip, spinal and wrist fractures, shortened stature and stooped posture.
But research has shown that osteoporosis also occurs among people who take steroid drugs for rheumatoid arthritis, asthma, inflammatory bowel disease, chronic lung problems and connective tissue disorders.
Steroids often quell the underlying inflammatory conditions that cause these problems. But when used at high doses, or for many months, the medicines impair calcium absorption and interfere with bone formation, said Dr. Henry Bone, director of the Michigan Bone and Mineral Clinic at St. John Medical Center in Detroit.
Last year, the American College of Rheumatology issued guidelines to prevent drug-issued osteoporosis. Among them:
Daily calcium intake of 1,500 milligrams. (An 8-ounce glass of 1-percent milk has 300 milligrams.)
800 international units a day of vitamin D, or 50,000 international units three times a week.
Bone density measurements at the onset of steroid therapy and six to 12 months later.
Dr. D. Sudhaker Rao, division head of bone and mineral metabolism at Henry Ford Health System in Detroit, said Michiganders and others in northern states especially need to watch vitamin intake because they don't get enough sunlight -- a good source of vitamin D.
"It's a myth among the public that if you do the usual things, you can avoid the drugs" for osteoporosis, he said. He and many others favor using drugs such as Fosamax, generically known as alendronate, or Didronel, generically known as etidronate, to prevent steroid-induced osteoporosis. Neither drug is federally approved for that use.
Children on steroid drugs, even if they take them occasionally, need up to 2,000 milligrams of calcium and 800 to 1,000 international units of vitamin D a day, Rao said.
The research presented Wednesday involved two Canadian studies. One showed that Fosamax plus calcium and vitamin D reduced spinal fractures in people taking steroids for a year or more, compared to a group getting only vitamin D and calcium. The other showed Didronel and calcium reduced the risk of vertebral fracture and height loss compared to steroid users getting only calcium.
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