Corticosteroid Induced Osteoporosis: Causes, Symptoms, Tests, Treatment- HRT, Tamoxifen
Corticosteroid-induced osteoporosis, as the name suggests, the results due to prolonged usage of corticosteroids. There are a good number of corticosteroids available few of which may include cortisol, methylprednisolone and prednisone, which are used by the patients who suffer with inflammatory conditions like muscle and joint pain, rheumatoid arthritis, gastrointestinal problems like inflammatory bowel disease and breathing problems.
While corticosteroids help in suppressing the inflammation, if used over a long period of time they carry with them some severe side-effects, one such being osteoporosis. Corticosteroids cause a decrease in absorption of calcium by the body, which leads to breaking down of old bone tissue and prevention of new bone formation ultimately leading to osteoporosis or loss of bone density.
Causes and Risk Factors of Corticosteroid Induced Osteoporosis
A human body's functioning involves both processes of new bone formation and breaking down of old bone. It depends on the body's ability as to how it can balance between these two processes and form dense and strong bones. One of the majors side effects of corticosteroids is that they cause a decrease in absorption of calcium by the human body, which leads to breaking down of old bone tissue and prevention of new bone formation thus ultimately leading to osteoporosis or loss of bone density.
Signs and Symptoms of Corticosteroid Induced Osteoporosis
The first signs of corticosteroid-induced osteoporosis may be easy fracturing of the hip or wrist. Compression fractures in the spine due to inability of the bones to bear the normal pressure of being in upright posture in an individual is another strong indicator of osteoporosis. Other symptoms include sudden severe pain in the back and loss of height.
Since osteoporosis is a known side effect of corticosteroids, bone density levels need to be monitored periodically as soon as the patient starts on corticosteroids to have a good control on the condition.
Tests to Diagnose Corticosteroid Induced Osteoporosis
A complete subjective and physical examination is necessary to diagnose the condition of corticosteroid-induced osteoporosis. Typically, a DEXA scan is required for measuring bone density.
Since osteoporosis is a known side effect of corticosteroids, the bone density levels need to be monitored periodically as soon as the patient starts on corticosteroids to have a good control on the condition.
Treatment for Corticosteroid Induced Osteoporosis
The first and foremost step toward treatment is to try to bring down the amount of corticosteroids being used, and much better if they can be replaced with nonsteroidal medications. Given below are few of the treatment modalities used to treat corticosteroid-induced osteoporosis.
Hormone Replacement Therapy (HRT): Hormone replacement therapy usually helps in preventing osteoporosis in women. However, this may also include side effects such as increased risk of gallbladder problems, blood clots and heart disorders. Hormone replacement therapy when taken with the combination of estrogen along with medroxyprogesterone acetate like Prempro for prolonged period may increase the risk of breast cancer.
If hormone replacement therapy does not work appropriately for corticosteroid-induced osteoporosis then other drugs that help in slowing down bone loss and increasing bone density may include:
- Bisphosphonates: Bisphosphonates help in preserving bone mass, reducing breaking down of the bone and also increase bone density in the hip and spine. Fosamax is the most commonly used bisphosphonate.
- Raloxifene: The good thing about Raloxifene is decreased risk of cancer retaining the positive qualities of estrogen with regard to bone density at the same time. However, it does carry some side effects the most common being hot flashes. Patients having a past medical history of blood clots should not use this drug.
- Calcitonin: Calcitonin is used by the patients who cannot use bisphosphonates and estrogen. Calcitonin helps in slowing down bone loss and preventing fractures of the spine; however, it does not help in preventing hip fractures. Calcitonin is used in the form of nasal spray due to which 12 percent of patients develop nasal irritation. Calcitonin is used by patients who are at a higher risk of fracture.
- Tamoxifen: Tamoxifen is an artificial hormone often used to treat breast cancer. Although tamoxifen helps in blocking effect of estrogen on breast tissue, but at the same time it also has estrogen-like effect on other cells of the body including bone cells. Tamoxifen may also have severe side effects.
- Statins: This class of drugs not only helps in decreasing the cholesterol levels but may also reduce the risk of bone fractures in women when they use statins for about a year or so. However, the drugs are not given on a daily basis for osteoporosis. Side effects may include potential reversible liver damage and muscle inflammation in rare cases.