Patients' Guide To
Spinal Fractures & Kyphoplasty

Steroid-induced Secondary Osteoporosis

Secondary osteoporosis is caused by a medical disorder or its treatment that is detrimental to the body’s efforts to build and maintain peak bone mass. Many people know osteoporosis is a primary cause of vertebral compression fractures (VCFs), and can increase the risk for subsequent spinal fractures. Another contributing risk and cause of VCFs related to secondary osteoporosis is a relatively common medication called corticosteroids can also cause bones to weaken and become prone to fracture. Corticosteroids (which are also known as glucocorticoids, cortisone, or steroids) are powerful anti-inflammatory medications available in cream, oral and injectable forms.
Older woman speaking to her Doctor, while Doctor has medication bottle in handIf your doctor prescribes you a corticosteroid, the goal is to relieve inflammation. Photo Source: How Does this Medication Harm Your Bone Health?
If your doctor prescribes you a corticosteroid, the goal is to relieve inflammation. Examples of commonly prescribed corticosteroids for back and neck pain include:

  • Dexamethasone (brand name Decadron)
  • Methylprednisolone (brand name Medrol)
  • Prednisone (brand name Deltasone)

Corticosteroids work against bone health in 3 main ways:

#1. They stimulate the activity of osteoclasts (which are bone-absorbing cells).

#2. They prevent the formation of osteoblasts (which are bone-building cells).

#3. They interfere with the small intestine’s ability to absorb calcium. Corticosteroids can prevent the small intestine from absorbing the calcium your body needs, and the calcium that’s not absorbed is excreted in your urine. When your body isn’t absorbing calcium from the small intestine, it takes calcium away from your bones. Calcium is an essential nutrient for bone health, and you can learn more in our article about calcium to build bone.

How Long You Use Corticosteroids May Influence Your Fracture Risk
As with any medication or treatment, corticosteroid use bears some risks. If taken for too long and/or at very high doses, corticosteroids can cause bone loss, osteopenia and/or osteoporosis. As such, these medications can increase your risk to lose bone mass density—that is, bone strength—that can lead to a vertebral compression fracture, or other types of spinal fractures.

Though long-term steroid use is linked to higher complication rates, a study published in April 2017 showed that adults using oral steroids for less than 30 days had a two-fold increased risk of fractures. To reduce fracture risk, the researchers recommended that patients use the lowest dose possible.1

Studies show that the greatest amount of bone loss occurs after the first year of corticosteroid treatment, and it’s estimated that as many as half of patients on corticosteroids will have a fracture at some point while on the medications2.

Fortunately, research has also found that patients experience a significant decline in fractures after stopping corticosteroid treatment3.

Working With Your Doctor to Reduce Your Spinal Fracture Risk
In some cases, corticosteroids are recommended for prolonged use. For example, some people with ankylosing spondylitis may use oral steroids as part of their long-term treatment plan. If you are taking a long-term or high-dose course of corticosteroids to manage your back and neck pain, it’s important you understand that the risk of osteoporosis and/or spinal fractures. Having a conversation with your doctor will help you understand how this risk applies to you.

If you are taking corticosteroids (also known as glucocorticoids, cortisone, or steroids) and are concerned about your risk for spinal vertebral compression fracture, talk to your doctor. He or she will help you weigh the risks and benefits of corticosteroid treatment. Your doctor may also reduce the dose of your anti-inflammatory medication, so you are able to manage both your pain and your fracture risk.

Updated on: 02/07/19
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Osteopenia and Osteoporosis: Is There a Difference?

While most people experience some loss of bone mass as they age, osteopenia and osteoporosis are not inevitable parts of the aging process.
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