Prednisolone therapy (corticosteroid therapy)
Adrenal insufficiency (Addison’s disease) / Hypopituitarism
Rheumatoid arthritis
Hyperthyroidism (overactive thyroid) and treatment with thyroxine (Oroxine, Eutroxsig)

Prednisolone therapy (corticosteroid therapy)

It is well known that long-term use of oral corticosteroid type medications such as prednisolone, cortisone, hydrocortisone and dexamethasone can adversely affect bone and lead to osteoporosis.⁵⁵

These medications are prescribed for a variety of conditions such as chronic airways disease, asthma, rheumatoid arthritis, inflammatory bowel disease, certain skin conditions, inflammatory conditions such as polymyalgia rheumatica, etc.

As a general rule long-term treatment (more than two months in duration) with doses of more than 5-7.5 mg of prednisolone per day increases the risk of osteoporosis.^56-58 In addition, if other risk factors for osteoporosis (such as being postmenopausal) are present, the effects of corticosteroid medication on bones will be more severe.⁵⁹

As the effects of corticosteroid medication can lead to rapid bone loss and subsequent fracture, it is important for women who are taking such medication to consider seeing their doctor about their bone health. Corticosteroids increase the risk of fracture by reducing bone formation, and hence bone density, but also lead to reduced muscle strength. In general even a moderate degree of bone fragility (e.g. T-score less than -1.0) will put a patient at high risk of fracture when taking corticosteroids.

Treatment with bisphosphonate therapy (e.g. risedronate, alendronate) is effective in reducing the bone loss associated with corticosteroid use. More recently, parathyroid hormone injections have also been shown to be particularly effective. Your doctor is the best person to assess your need for bone preservation therapy.

Adrenal insufficiency (Addison's disease) / Hypopituitarism

Women (and men) with Addison's disease (deficient in cortisol) or hypopituitarism (pituitary gland failure) require long-term physiological replacement of cortisol with corticosteroid drugs (e.g. cortisone, hydrocortisone, prednisolone). There is increasing evidence that the replacement doses of cortisol used in these conditions can lead to osteoporosis. Usually, this is in the setting of over-replacement with these medications^65-68 or when there are other co-existing risk factors for osteoporosis. Hence, it is important for women with these conditions to discuss with their doctor whether they need to have a bone check.

Rheumatoid arthritis

Rheumatoid arthritis is a condition which affects approximately one per cent of the population, with approximately three times more women affected than men. It is a condition that usually develops between the ages of 25 and 50, but is not uncommon in the elderly.

Rheumatoid arthritis leads not only to joint damage but also to osteoporosis, especially in bones adjacent to the affected joints. If prednisolone is prescribed as part of the medical treatment, this can also lead to the development of osteoporosis.⁶⁹

Women with rheumatoid arthritis or any other connective tissue disease (e.g. lupus, scleroderma) need to discuss the issue of having an assessment for osteoporosis with their treating doctor.

Hyperthyroidism (overactive thyroid) and treatment with thyroxine (Oroxine, Eutroxsig)

It is recognised that conditions such as Graves’ disease or toxic multinodular goitre, which result in an overactive thyroid (too much thyroid hormone production), can lead to osteoporosis. Excessive concentrations of thyroid hormone lead to more bone breakdown than bone formation, which in turn causes a reduction in bone density. The adverse effects on bone usually subside when the condition is treated and the amount of thyroid hormone produced from the thyroid gland normalizes.

There has also been concern about the risk of over-replacement with thyroxine hormone (sold as Oroxine and Eutroxsig). Sometimes this is done as part of routine treatment for thyroid cancer and multinodular goitre (benign, non-toxic). If women are at all concerned about the effects of over replacement with thyroxine, it is recommended that they discuss this with their treating doctor.

Content updated July 29, 2011