Steroids and Osteoporosis

[FiddleFern]

2 Queries - can anyone point me towards the science of how steroids contributes towards osteoporosis ? And the 2nd is , are there any studies re use of steroids below 7.5mg and impact on osteoporosis. I am well aware that as we reduce down , the side effects begin to diminish I would be interested to read any studies around this . Thanks to all you wonderful people who hold this space .

[PMRpro Ambassador]

Both were mentioned in the talk by Prof Emma Clark at the charity AGM - it was recorded so if you are a member you could get the link from Fran Benson.

"Glucocorticoids decrease the function of the remaining osteoblasts directly and indirectly through the inhibition of insulin-like growth factor I expression. The stimulation of bone resorption is likely responsible for the initial bone loss after glucocorticoid exposure."

pubmed.ncbi.nlm.nih.gov/128....

The 2 main effects of GCs on bone metabolism are (1) inducing apoptosis in osteoblasts and osteocytes, thereby decreasing bone formation, and (2) prolonging the lifespan of osteoclasts and increasing bone resorption, Osteoblasts are the cells that form new bones and grow and heal existing bones. They release bone matrix that turns proteins into new tissue. Bone matrix fills in gaps and spaces in your existing bone tissue. So they work more slowly. Osteoclasts break down old bone to be replaced but this effect is increased by pred and that therefore increases. More breakdown, less rebuilding, is the imbalance that leads to bone density loss.

It was known 20 years ago that 5mg still increased the indices of bone resorption

pubmed.ncbi.nlm.nih.gov/157...

but The ROS mentions a dose of 2.5mg as still increasing the risk for fracture but doesn't give a reference, I assume it is this

ncbi.nlm.nih.gov/books/NBK2...

theros.org.uk/information-a...

and I'm fairly sure there has been work by physiotherapists showing no dose is entirely safe in terms of bone fracture which surprised the rheumies (including Prof Mackie) and of course - I can't find it.

[FiddleFern in reply to PMRpro]

That’s great thank you for your in depth reply gives me lots to read / study . 😊