Steroid-Induced Osteoporosis

What Is Steroid-Induced Osteoporosis? 

Steroid-induced osteoporosis is a condition where bones become weak and break more easily because of long-term steroid use. Steroids (also called glucocorticoids) are medicines that help reduce inflammation from conditions like asthma or arthritis. Common types include dexamethasone, prednisolone, prednisone, and hydrocortisone. A known side effect of these medicines is lower bone density in both children and adults.

What Causes Steroid-Induced Osteoporosis?

Steroids can slow normal bone growth and cause bones to lose calcium, making them weaker. People who take steroids for more than 3 months or have more than 3 courses in a year are at higher risk.

What Are Signs & Symptoms of Steroid-Induced Osteoporosis?

Steroid-induced osteoporosis looks similar to other types of osteoporosis. Common signs include:

• Bone pain, often in the back, arms, or legs
• Multiple fractures in the spine or long bones, even from minor injuries
• Physical changes like short stature or trouble walking

How Is Steroid-Induced Osteoporosis Diagnosed? 

Your provider may order:

• Blood tests for calcium and vitamin D
• X-rays
• DXA scan (bone density test)

If bone density is low and there are fractures, a diagnosis can be made.

They may also check if your body makes enough cortisol, a natural steroid that helps maintain blood pressure during illness. If your morning cortisol is low (<10 mcg/dL), you may need a steroid action plan for times of illness.

How Is Steroid-Induced Osteoporosis Treated?

First, we will be sure there is enough calcium and vitamin D to help bones. We may recommend physical or occupational therapy, or a referral to an orthopedic surgeon to manage fractures or pain.

Steroid induced osteoporosis can improve on its own if steroids are no longer needed. If the osteoporosis worsens, does not resolve on its own, or provides significant limitations to daily activity, we may recommend a medications called bisphosphonates.  

What Are the Long-Term Effects of Steroid Induced Osteoporosis?  

If untreated, osteoporosis can lead to repeated fractures, bone pain, and deformities.