As I reduce my prednisone does it lessen the impact on my bones?

[bunnymom]

I have taken prednisone daily for almost 5 years. At my last dexascan my femur was down a point but the rest of my numbers were about the same. The scans were two years apart and on different machines. The Dr has prescribed fosamax which I am unlikely to take. I am 64 and 5 ft 3. I would like to try to manage this naturally.

Will I have the negative bone effect the whole time I’m taking the prednisone ? Is it possible to go natural and have success while on this medicine. I probably have a year or two till I’m off.

[Mark_ABH]

Hi Bunnymom, prednisone and other glucocorticoids, which are prescribed to treat inflammatory and other conditions, can be bad for the bones. The issue is not just bone density, but also bone quality. This refers to the microarchitecture inside the bones -- think of it as the bone structure.

A DXA measures only the bone density/mass, but there is a technology called TBS that scans the texture of your DXA image to determine your bone quality. It's software that is added on to a DXA machine. Studies have shown that TBS enhances the ability to assess fracture risk and make treatment decisions, such as whether an osteoporosis medicine is needed. Ask your health care provider if they offer this technology or if they know someone who does.

Here's a resource we recently created that talks more about bone quality and how TBS helps measure your fracture risk. americanbonehealth.org/unde...

There's a tool on that page to locate a TBS provider near you if you're in the United States. americanbonehealth.org/tbs/

Remember, the concern here is not bone density per se, but your risk of breaking a bone. Long-term use of steroids is a significant risk factor. We invite you to use our Fracture Risk Calculator to assess your risk of breaking a bone in the next 10 years based on a variety of factors. This is a scientifically validated tool designed for use by individuals in the United States. americanbonehealth.org/calc...

Please ask your health care provider how to manage the risk to your bones if you don't want to take an osteoporosis medicine. They might prescribe a lower dose of the prednisone or wean you off it.

[bunnymom in reply to Mark_ABH]

Thank you. I will look into this information.

[Herinspain]

I don't know why, but someone on this site thinks I am taking Fosamax. The programme I am on is (in English) Forteo (in Spanish it is Forsteo). I live in Spain. This is a 2 year programme, one injection daily. Due to the national health here, it is costing me 18 euros per month. I know it more more costly in the UK and the US. If anyone has been on Fosamax, you cannot take part in this treatment. It is supposed to put up to 19% on bone on, but I guess I will find out if that is true at the finish. I have been on it for 2 and a half months. Time will tell.

[HeronNS in reply to Herinspain]

Teriparatide may be one of the drugs which requires follow-up treatment after it is discontinued, so they may advise you take a bisphosphonate for a while at the end of your two years. I haven't heard that it causes the same dramatic and in some cases calamitous rebound osteoporosis that is associated with discontinuing denosumab (Prolia) but I have read that one can expect a gradual loss of the bone density gained during the teriparatide (Forsteo) treatment. I also don't know whether starting a natural regimen works as well post-Forsteo as it does for someone who has never taken any OP drugs but surely it would do no harm?

[Mark_ABH in reply to HeronNS]

Correct, here's what our Frequently Asked Questions document says:

Other osteoporosis medicines such as denosumab (Prolia®), teriparatide (Forteo®), abaloparatide (Tymlos®) and romosozumab (Evenity®) must be followed by another medicine.

In the case of teriparatide and abaloparatide, using a bisphosphonate or denosumab will help maintain the gains in bone density made by the two bone building medicines.

When medicines like denosumab and romosozumab are stopped, the metabolic process that they were inhibiting resumes and there can be rapid bone loss.

Do not stop any medicine for osteoporosis before you talk with your health care provider.

[Herinspain in reply to Mark_ABH]

Thanks for your input, Mark and Heron. I am seeing an osteoporosis specialist at my local hospital next month. I have printed off both your emails to take with me and will show them to her to see what she has to say....

[Karenjaninaz in reply to Herinspain]

I started Forteo in the US since I have osteoporosis but I ended up in hospital with shortness of breath - worse than my usual. My oxygen went down to ~ 90 %- never a smoker. Doc said there is a 3% incidence of shortness of breath with Forteo. Too bad.. I was willing to do my daily injections for 2 years. Cant tolerate Fosamax and terrified of any more injections.

[HeronNS]

I've been on prednisone (low dose) since mid-2015. I had a DXA scan that year, after several months on the medication ,which showed I had "low bone mass" aka osteopenia. My doctor wanted me to take alendronic acid but I'd done so much reading by then I wasn't prepared to risk it. I started a "natural" regimen including exercise, supplements and a good diet and by the time of a second scan one year later I had improved the femoral neck reading from -2 to -1.6 without using any bone medication. I've not had another scan since then but carry on with the same regimen. You can read my account written at the time here: healthunlocked.com/pmrgcauk... I still take pred - it's been around 2 mg for about four years.