Home › Resource Hub › Fact Sheets › Glucocorticoids and Bone Health Glucocorticoids and Bone Health Protecting bone health Bone health is an important part of your general health. When the structure of bone becomes weaker and less dense, there is an increased risk of breaking. This is osteoporosis. It can lead to a higher risk of bone breaking from a minor incident (such as a bump, fall or trip). Early diagnosis and management of osteoporosis can help protect bone health and reduce the risk of breaking a bone. Glucocorticoids and bone health Glucocorticoids (sometimes called corticosteroids, steroids or cortisone) reduce inflammation and are prescribed to treat many medical conditions, including asthma and arthritis. Glucocorticoids are effective treatments, and the most commonly prescribed are prednisolone and dexamethasone. However, this medication can also impact bone health and lead to an increased risk of osteoporosis. Therefore it is important to protect your bone health while taking glucocorticoids. Glucocorticoids and their effect on bones Bone is living tissue – older bone is constantly removed by bone-resorbing cells and is replaced with new bone made by bone-forming cells. This process keeps the skeleton strong. Glucocorticoids can slow down cells that form new bone and result in the bones gradually losing some strength and can be prone to fracture. Glucocorticoids may also interfere with calcium absorption in the intestine and how the kidneys manage calcium. Hormone levels may also be reduced, impacting other important factors for maintaining bone health, such as vitamin D. Do all glucocorticoids affect bones? This depends on how the medication is prescribed in dose, how often, and how long. Glucocorticoid injections may affect the bones if the injections are frequent. Injections given directly into the joint to treat arthritis do not significantly affect bones. Dose – taking glucocorticoids at higher doses (7.5mg or more per day) for at least three months lead to a higher risk of osteoporosis and fracture. Intermittent high doses (tablets) taken for short periods (less than three months) or lower doses (2.5mg –7.5mg daily) may increase the risk of fracture in some people. Glucocorticoid tablets are usually at a higher dose than in asthma ‘puffers’ or in skin creams and are, therefore, more likely to affect the bones. However, using an asthma puffer frequently over a long period can also increase the risk of osteoporosis. Will I need to take drugs to protect my bones while I’m taking glucocorticoids? If you are taking glucocorticoid for at least three months, your doctor may recommend a treatment to protect your bones. Your doctor may refer you for a bone density scan and review your bone strength before deciding whether a treatment is needed to prevent osteoporosis. Other Common Risk Factors Review other common risk factors for osteoporosis. If any risk factors apply to you – discuss these with your doctor. Personal History Previous fracture (from minor bump or fall) Family history of osteoporosis (parent/sibling) Loss of height (3 cm or more) Smoking/Excessive alcohol Inadequate calcium, vitamin D or lack of exercise Age 70 years and over Medical Conditions Coeliac disease Diabetes Rheumatoid arthritis Early menopause/Low testosterone Chronic kidney disease or liver disease Overactive thyroid or parathyroid Medications Certain treatments for breast cancer Certain treatments for prostate cancer Glucocorticoids (steroids) Anti-epilepsy treatment Calcium, Vitamin D, Exercise Take simple steps to help support your bone health. Focus OnRecommendedCalcium• 1,000 mg per day from the diet• Increasing to 1,300 mg for women over 50 years and men over 70 years• If dietary intake is low a supplement may be requiredVitamin D• Limited sun exposure – in summer, a few minutes per day, in winter slightly longer• Avoid UV index above 3• If vitamin D deficiency is confirmed by your doctor, a supplement may be requiredExercise• Specific mix of weight bearing, resistance training and balance exercises