Prednisone and necrotic hip

[OutdoorsyGal]

My mom had PMR in her 80’s and couldn’t get off prednisone. Eventually she developed a necrotic hip and had to have a hip replacement at 85. I don’t know what dosage she was on, or for how long. (I didn’t realize her experience might be relevant to me 10 years later, and she’s not around to ask any longer.)

Anyone else develop necrosis from prednisone? What was your prednisone dosage and duration? I’m afraid of going back on prednisone to treat a relapse because I don’t want to have my hip bones rot.

[Bronni]

My gp had a necrotic hip from, what she described, as ‘low dose’ prednisone. I really need to ask her more details, but needless to say, she is a nervous wreck about my taking it for 4 + years! 😱. Obviously this can happen, but there are way more stories on this site of managing pred for years without side effects being too harmful. Personally, I’ve been fine, but spent very little time on over 5mgs.

[OutdoorsyGal in reply to Bronni]

Thanks, Bronni. I was given 15 mg for the first 3 weeks, then 10 for a month, then decreasing by one mg per month, ending Dec 31st.

I have no idea how much they gave my mom, or what dose she was on when she had to have her dose increased.

I just don’t want to go through what she did, but I think my PMR is relapsing...

[Bronni in reply to OutdoorsyGal]

Ive honestly not heard anyone mention it (necrosis) on here, but I’m a relative newbie. Nor have I heard of anyone being on a year long treatment program!! The latest info shows pmr last approximately 5+ yrs. Most drs no longer believe that it will end in one to two years. It’s important to get to the lowest dose of pred that controls the symptoms, not to try and end treatment before you’re ready. I’ve been on 1 1/2 - 2mgs for over 3 yrs now. I feel well, but pmr has not finished with me yet!

[SnazzyD]

I bet you’re worried. However, I think it is impossible to know without without the medical history and dose management. It’s like any drug though, there will always be individuals who get the worst things on a drug. Plus, you don’t know what other factors predispose a person to the adverse event. For example, there are people who’ve had liver failure from Paracetamol, even on normal doses, but we still take it. Also, there may have been other drugs in the mix that didn’t help. In any case, the thing with this condition is that there are worse demons to worry about in not taking it. It sounds like Hobson’s choice but for the vast majority it’s much better than that.

[OutdoorsyGal in reply to SnazzyD]

Thanks snazzy. I tend to be an optimist about my odds, but like to do the research ahead of time.

[gifford7]

see: ncbi.nlm.nih.gov/pmc/articl...

"Glucocorticoid-induced osteonecrosis......................

Awareness of the need for prevention of glucocorticoid- induced fractures is growing, but glucocorticoid administration is often overlooked as the most common cause of nontraumatic osteonecrosis. Glucocorticoid- induced osteonecrosis develops in 9–40% of patients receiving long-term therapy although it may also occur with short-term exposure to high doses, after intra-articular injection, and without glucocorticoid-induced osteoporosis.......................................

Current evidence indicates that bisphosphonates may rapidly reduce pain, increase ambulation, and delay joint collapse in patients with osteonecrosis.........

An investigation of the epidemiology of osteonecrosis requires a search using several different aliases as the disorder is also known as aseptic, avascular or ischemic necrosis or bone infarcts [15]. The annual incidence of all types of osteonecrosis doubled from 1989 to 2003 (from 1.4 to 3/100,000), perhaps due to the more frequent use of MRI [16]. Most commonly, the hip is involved but almost any bone can develop osteonecrosis. The most frequent etiological factors are trauma, alcoholism, and glucocorticoids, the later causing the most devastating form of osteonecrosis [11] "

[OutdoorsyGal]

That’s helpful. And depressing!

Thanks.

[PMRpro Ambassador]

It is mostly high dose steroids that are associated with AVN and there are other things that cause it too.

mayoclinic.org/diseases-con...

But as Snazzy says - look at all the other things you take that have just as problematic potential adverse effects. You wouldn't take anything!

I think there has been one person on the 3 PMRGCA forums in 10 years with hip AVN - but they may have been taking bisphosphonates too and they are responsible for more cases I think.

[OutdoorsyGal in reply to PMRpro]

My mom WAS in Fosamax for several years. I am not though I

AM mildly osteopenic, acc. to DEXA scam in July.

[OutdoorsyGal in reply to OutdoorsyGal]

Typing in car on bumpy road = interesting typos!

[PMRpro Ambassador in reply to OutdoorsyGal]

Part of the reason Fosamax should only be used for 3 years max - the skeletons are crawling out of the woodwork there too!!