Risks of osteoporosis while taking prednisone for nearly 2 years.

[BPlady]

Hello everyone! I have been on prednisone for nearly 2 years now having been diagnosed with PMR in November 2019 and starting on 15 mg with a horrible GP who insisted I needed to come off them ASAP, which ended in countless flares which needed me to go back up to the starting dose again!!!

Luckily, I found a locus doctor at my practice who seemed to understand the problem and worked with me to reduce dosage very slowly, and I am now on 4.5mg reducing to 4 mg by the end of this month, and it’s going well🤞.

The question I have is could this length of time being on quite high doses have an effect on my bones? During the last few months I’ve had two of my teeth crumble and now I have a hairline fracture in my wrist from just stringing my beans from the garden. I now have my wrist in plaster and finding things really frustrating!

Can anyone help with any advice please?

[jinasc]

Yes. ask your GP for a Dexa scan - according to the Diagnosis and Treatment of both PMR and GCA should be done after 6 months on pred.

Just in case you run into trouble with GP I would download them - they are in the FAQ's, print and take them with you or send via e-consult or email.

[BPlady in reply to jinasc]

Thank you, I will take all this advice and see what happens!👍

[MrsNails]

Hi, have you had a Dexa Scan to check your Bone Density? There is lots of information on Bone Density in FAQ - which you will find very helpful.

Kind Regards

MrsN

If you haven’t had a Bone Density - you need one ASAP

[BPlady in reply to MrsNails]

Thank you; I’m going to get on it!😀

[BPlady in reply to MrsNails]

Thanks so much! I’m on it!!x

[SnazzyD]

Hello, whilst many peoples’ bones are affected minimally by being on Pred, you don’t know which you are. I would have thought a non traumatically caused fracture is enough to make the GP consider a DEXA in any case. If you do have osteoporosis you won’t know if you already had it before Pred if nobody did a baseline. That GP didn’t do you any favours causing the flares and potentially making your Pred journey on higher doses longer. I do wonder what those kind of docs think they are achieving sending the patient into a life of pain and if they flare badly, what then?

[BPlady in reply to SnazzyD]

I know! I’ve been in pain for most of my adult life, what with Fibromyalgia, a spinal injury, arthritis and now PMR, but, sadly, “it’s only pain; keep taking the tablets! 😒

[Kendrew]

Hi BPlady, The simple answer is, yes.... pred can bring about some deterioration in the bones but there are quite a few lucky people for who the pred has little if no effect on bone health. That's why it's important to have a DEXA scan to see whether there is any indication of osteopoenia or osteoporosis and if there is, then clearly medication may be necessary. I think the issues you've been experiencing probably require a DEXA scan to clarify the situation, but remember that there are still many things you can do to improve bone density yourself and as you've already been advised, there's a lot of really useful information in FAQ'S section.

[BPlady in reply to Kendrew]

Thank you! I always get really good advice from you all and will definitely follow it up!😀

[PMRpro Ambassador]

You should have had a dexascan within the first 3 months of being on pred to get a baseline reading. However - you haven't been on very high doses, 15mg is classed as moderate, but it isn't possible to forecast how your bones reacted. I've been on above 10mg for much of the last 12 years but my bone density hasn't really changed markedly, it is still good enough not to need any treatment. Others are found to have low bone density anyway, yet others find even low doses of pred lower the bone density.

I am surprised that fracture clinic didn't order a dexascan after a low impact fracture though.

[BPlady in reply to PMRpro]

Thank you, I remember having bone density scan many years ago when I had a toe injury; it was fine then so I didn’t worry with this injury.

[Nextoneplease]

Hi BPlady 😊

Can I just echo what others have said…..a DEXA scan sounds like the right thing for you. If your bones are affected, there is medication you can take, as well as calcium supplements and vitamins D3 and K2. The first two of these are prescribed for me by my GP, as is medication for osteoporosis.

Prevention is the name of the game. Your bones may not be affected, but if they are, you need to start treatment ASAP. The DEXA scan is the key to this, or if there’s a long wait, your GP can do a blood test for vitamin D levels etc and might start you on at least some treatment while you wait for the scan.

All the very best 😊

Nextoneplease x

[BPlady in reply to Nextoneplease]

Thank you, I will definitely try and get a test, however, my GP is not the most accommodating to put it mildly! I’ll have to try and see a locus!

[Nextoneplease in reply to BPlady]

Please do try to find a locum or other responsive GP. I am quite surprised that no one’s picked this up - you shouldn’t get a stress fracture from stringing beans!! (as I’m sure you know 😊) x

[BPlady in reply to Nextoneplease]

Yes, I will, thank you.x

[piglette]

As the others say get a Dexascan if you have not had one and also make sure you are prescribed vitamin D with calcium to help your bones. My bone density is fine after five years on pred.

[Deyazlex]

Did your doctor not prescribe a weekly alendronic acid tablet and twice daily D3 chewable tablets to work alongside the prednisolone to help prevent likelihood of osteoporosis ?

[Croft9232]

Just to add also …that if you do need a Dexa and there is a long waiting list then they are one of the cheaper tests to have done privately around £150.Margaret.

[BPlady in reply to Croft9232]

Thank you, Margaret; I will look into that.😁

[Exflex]

You don’t mention taking Alendronic Acid (or similar) and calichew D3. I was prescribed these from day 1, which was 22 months ago when I started on 15mg. I’m currently transitioning from 6.5 to 6mg and I still take both of these. I have had two accidental falls doing DIY and I would like to think AA and Calcichew D3 are doing what they’re supposed to do. From my experience I would recommend everyone on Prednisolone takes these, as I do.

[paintpots]

I would have thought you should have been taking Alendronic acid and some sort of calcium tablet from day one of your PMR journey, and possibly Omeprazole. My first doctor did not prescribe them, but a new doctor 1 month after my prednisolone was started put me on them. And am I glad because I have had a fall and hit my wrists on the pavement with nothing broken except my pride.