As we age, many of us are subject to various medications for a host of chronic ailments. And osteoporosis is possibly not least of these. But while medicine is important, and in many cases vital to our wellbeing, there is often the glaring issue of side effects. So from the innocuous vitamin tablet to the more serious stuff for heart, blood and kidneys, we can be sure that along the pill-popping path there may well be something that causes an upset – fixing one thing while compromising another.

Cortisone is one of those medications that can have a number of side effects, and can upset some people more than others. Certainly if you are suffering from osteoporosis and you are prescribed cortisone, you would do well to consider the ups and downs of this solution on what may be an already stressed bone structure.

Perhaps not good, but then not all bad

The ups and downs:
Cortisone, also known as corticosteroids or glucocorticoids, can have both positive and negative effects on the bones, depending on various factors such as dosage, duration of use, and individual susceptibility. While cortisone can be an effective treatment for various medical conditions, including inflammatory disorders and autoimmune diseases, its prolonged or excessive use may lead to adverse effects on bone health.

The danger of long duration:
The impact of cortisone on bone health varies depending on the dose and duration of treatment. Short-term use of corticosteroids, such as a brief course to manage an acute condition, is generally considered safe in terms of bone health. The risk of bone loss and fractures of especially the vertebrae, increases with higher doses (a dose of greater than prednisolone/day) and longer durations of corticosteroid therapy. Increased fracture risk even occurs at lower doses (2.5 -7.5mg/day). The most rapid bone loss occurs most rapidly within the first 3-6 months of therapy and a baseline bone density is therefore imperative before start of treatment.

Bone density:
One of the primary concerns regarding cortisone and bone health is its potential to induce bone loss, a condition known as corticosteroid-induced osteoporosis. Cortisone affects bone remodelling by inhibiting the formation of new bone and increasing bone resorption, leading to a loss of bone density and strength. This effect is particularly significant in the spine. It is estimated that approximately 30% to 50% of patients on long-term corticosteroid therapy will develop corticosteroid-induced osteoporosis.

Essential nutrients:
Furthermore, cortisone can interfere with the balance of calcium, vitamin D, and other essential nutrients in the body, further compromising bone health. Corticosteroids decrease calcium absorption from the intestines and increase urinary calcium excretion, which can contribute to bone loss over time. Additionally, cortisone can suppress the production of active vitamin D, which is crucial for calcium absorption and utilisation.

Corticosteroid-induced bone loss can increase the risk of fractures, particularly vertebral and hip fractures. These fractures can have severe consequences for individuals, leading to pain, disability, and a decrease in overall quality of life. It is important to note that the risk of bone loss and fractures is higher in individuals who already have other risk factors for osteoporosis, such as older age, menopause, low body weight, and a history of previous fractures.

Strategies to mitigate the adverse effects of cortisone on bone health

  • It is important for individuals taking corticosteroids to discuss their concerns about bone health with their healthcare provider, who can assess their risk factors and develop a comprehensive plan to minimise the adverse effects on the skeleton.
  • Healthcare professionals may recommend several ways to alleviate any side effects. These may include: the use of the lowest effective dose for the shortest duration possible; regular monitoring of bone mineral density through bone density scans; and the implementation of lifestyle modifications to support bone health.
  • Lifestyle modifications may involve ensuring an adequate intake of calcium and vitamin D through diet and supplements, engaging in weight-bearing exercises, and avoiding tobacco and excessive alcohol consumption.
  • In some cases, healthcare providers may also prescribe medications called bisphosphonates to prevent or treat corticosteroid-induced osteoporosis. Bisphosphonates help to inhibit bone breakdown and reduce the risk of fractures in individuals taking corticosteroids.

Love your bones! Keep them in mind when using any kind of medication – but especially take care with cortisone.

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

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