Need for Calcium supplements?

[Flinders61]

I have been on prednisolone for 10 months for PMR, recent flare at 7mg so now on 10mg until resolved. My Dexa scans show no significant bone loss, currently not taking any supplements. Should I commence them as still have some way to go on this journey!

[Kendrew]

Hi Flinders61,

There's probably not a straightforward answer to this question as certain variables may need to be considered.

I was automatically put on Calci-D (a calcium and Vit.D combined supplement) when I was first prescribed prednisolone. This was because steroids can decrease the amount of calcium the body can absorb and this may then lead to bone loss / osteoporosis. So there is an argument that taking them as a precautionary measure may be sensible.

However, I've had 2 DEXA scans, (three years apart) and the first showed evidence of the need to take them but the second one didn't, so I came off them because they didn't particularly agree with me.

I continue to take a good, high dose Vit.D3 supplement though and I eat a diet that's rich in calcium.

I also take Vit.K2 which is necessary to ensure that the majority of the calcium I ingest is directed to my bones rather than my blood vessels (as can otherwise happen.)

All my blood tests since have shown calcium and Vit.D levels that are well within normal parameters and the most current DEXA scan showed a significant improvement in my bone health. It's therefore for these reasons that I made the decision to stop taking the Calci-D.

I personally prefer to not take any form of medication... including supplements.... unless there is evidence to support that need.

My own individual situation will obviously be different to yours and you will have to weigh up your own risk factors to determine whether you should or shouldn't take a calcium supplement.

The information you've given suggests that currently your bone health is good with no evidence of deterioration but of course this may change in the future, depending upon how long you're taking the steroids and the dosage.

In your current circumstances, I probably would decide to not take the calcium supplement at the moment, but I would definitely take a Vit.D3 supplement with the Vit.K2. I would also monitor my calcium levels through regular blood tests and request another DEXA scan at the appropriate time.....just to keep an eye on things.

As I touched on before, you need to weigh up all the pros and cons and make a decision based on what's right for you, but hopefully my 'story' has maybe given you a few pointers to consider before making any decision.

[Flinders61 in reply to Kendrew]

Thank you for such a comprehensive reply. Your situation mirrors mine & I also have improved dexa scans. I only take medication when supported by evidence but became concerned I was perhaps becoming too rigid in my parameters! Clinical research background can be a double edged sword. I will review Vit.D3 & Vit.K2.

[Missus835]

I take a generic anti-acid tablet, which contains 1000 mg calcium (am I allowed to say the brand name). Also, there is a K2+D3 which I take along with another 2000 D3, also C. Rheumy was happy with this. Yogourt and other calcium-rich foods. That's about it.

[DorsetLady PMRGCAuk volunteer in reply to Missus835]

You can use brand band -and say it works for you -so long as you aren’t blatantly promoting it… then it’s up to others to decide if they want to try it.

[BettyE]

During two spells of PMR ( three years and five ) I was prescribed Calceos. Alendronic acid was tried but stopped due to adverse effects -made me wheeze. The calceos must have done the trick as I was told, following a hip replacement, op that I had " amazing boned density for my age ." ( 77 at the time. )

[PMRpro Ambassador]

You should definitely be ensuring you have an adequate supply of calcium, preferably a bit above the RDA since pred tends to "wash" it out, and absolutely vit D. Calcium need not be supplements - very much depends on your diet and dietary calcium is far preferable to tablets but they are useful of you are struggling n the dietary front. Vit D needs to be supplements - relying on sun is not enough, useless between September and May in the UK and even when the sun shines, as you age your skin factory goes on a go slow ...

Has your vit D level been checked to see if you are deficient? That alone can cause PMR-type aches and pains and needs remedying. Pred also lowers that in the body and I find anything less that 4000 IU per day results in my vit D level slowly falling to depleted levels again.

[Galore]

I've been on pred. Since Oct 2022. Now down to 9 mg and all ok. Also on adcal/D3, Alandronic acid, methotrexate, folic acid Lanzaprazole! Spoke to Dr friend yesterday and he suggested if I start having pains etc as pred reducing he suggested 9mg one day and 8mg the next for few wks. Seemed a good idea if I do start having problems. Also said eyes can seem watery/hazy with the pred - mine do sometimes. Have yet to have bone density check so that will be interesting having been on adcal since Oct.

[PMRpro Ambassador in reply to Galore]

We have slowed tapering schedules that help with the step down - we think alternating doses like that is a bit of a hammer to crack a nut and are hard on the body. The schedules are under Tapering in the FAQs

[Galore in reply to PMRpro]

OK thanks for info will look at FAQ. Don't have problem at the moment just thought good advice but maybe not! On another point what can I do to help the adrenals as tapering? Probably in FAQ? Food etc? Also advised today cholesterol hi but think that is sterroids?

[PMRpro Ambassador in reply to Galore]

Not really anything you can do for the adrenals except eat a good diet, reduced junk and sugar. Their stimulation is when the pred dose is lowered consistently so yoyoing the dose doesn;t help, it needs to be lower than the amount your body needs to get the body to signal it needs a cortisol top-up

[Galore in reply to PMRpro]

Great thanks for that will throw the biscuits away! Think I eat a reasonably balanced diet! Might have a magnum treat occasionally!! 🤔

[PMRpro Ambassador in reply to Galore]

Have to be occasional treats - otherwise you want to give up the healthy bit.

[HeronNS]

Please add Vitamin K2 (not K1) as it is very important for sending calcium to the bones, and is often deficient in the modern diet.

[springeramber]

Hi Flinders61

I have been on prednisolone for 4.5 years had a dexa scan at the start and also this year both very good so I have never been on calcium( my diet was deemed good enough) lots of milk cheese eggs etc and chocolate inmoderation!!! - i was on alendronic acid to start with but on querying it I was told I could stop it - like you I do not like taking supplements but do take D3 and a multivitamin (for the oldies!) I have had an up and down from 40mg with various diagnosis and trial Methotrexate and still on tocilizumab which I was lucky to get = now at 3 - adrenals all working- supposed to be reducing to zero but seem to be stuck at 3 and would be happy with that but my Rheumy is one that is desperate to get you off!!

I am going to start taking turmeric as I have heard great reports about and a friend has had great success for RA and I also have a bit of OA- the rheumy nurse poo pooed it - not enough evidence!! but i will give it a go as one must at 80!!!

[Bcol]

Morning Flinders61, I have never taken extra Calcium as I felt my diet pretty much covered what I needed and the two DEXA scans have shown no problems. I do take Vit D and K2 though. No other supplements.

[Mayadill]

Do you drink milk? Once out of hospital and back to my usual diet I dropped the supplemental Ca and D. I took a multi vit anyway taking care of the D and I always have drunk lashings of milk, between 750 ml and a litre a day, and that can be more calcium than in the pill (tablet I got was 1200 mg, milk 130 mg per 100 ml). Also excess calcium is not a nice thing to have.