Oral Body Steroids

Oral Body Steroids (Glucocorticoids) and Bone Health in Canada

Oral body steroids, particularly glucocorticoids, are frequently prescribed in Canada for various medical conditions. However, these medications can have an adverse impact on bone health, increasing the risk of osteoporosis and fractures. This risk is more pronounced under certain circumstances:

– Use of high doses of steroids
– Administration of steroid tablets
– Extended use, particularly beyond three months

Understanding Steroids

Oral body steroids, including glucocorticoids, are hormones produced naturally in the body in Canada. They play a crucial role in maintaining cellular health and regulating growth, as well as the body’s responses to stressors like infections, injuries, and inflammation. Common steroid medications include prednisolone, dexamethasone, hydrocortisone, and cortisone. These treatments serve various purposes, such as:

– Reducing inflammation for conditions like asthma, rheumatoid arthritis, lupus, inflammatory bowel disease, polymyalgia rheumatica, or giant cell arteritis
– Supplementing hormones when the body is unable to produce enough due to adrenal or pituitary disorders
– Decreasing the likelihood of organ rejection following an organ transplant

Effects of Oral Body Steroids on Bone Health

The strength and density of bones depend on a delicate balance between bone formation and breakdown. Oral body steroids can disrupt this balance in the following ways:

– It may activate the cells responsible for bone resorption.
– They can slow the activity of osteoblasts, the cells that create bone.
– They may impair the body’s ability to absorb calcium, leading to less calcium being available to fortify bones.
– Steroids can also influence levels of sex hormones, like estrogen and testosterone, which may affect bone density.

Overall, the use of steroid medications can lead to the accelerated breakdown of bone, resulting in a higher risk of osteoporosis and fractures.

While concerns regarding the side effects of oral body steroids are valid in Canada, it is essential to recognize that all medications come with both benefits and potential risks. Not everyone will experience weakened bones or fractures. Healthcare professionals work to ensure patients receive the lowest effective dose to manage their condition, thereby minimizing the likelihood of adverse effects, including bone weakening.

Several factors can influence the degree to which bone strength is impacted, including the specific type of steroid used, the dosage, and the duration of treatment.

Steroid Tablets

Oral glucocorticoids, such as prednisolone, are more likely to contribute to bone loss if taken for over three months or if given frequently in shorter courses. The relationship between dosage and risk is still being studied current evidence suggests that even low doses (approximately 2.5 to 7.5 mg of prednisolone daily) may elevate the risk of fractures, and higher doses increase this risk further.

Steroid Injections

Steroid injections may be administered intravenously (into a vein) or intramuscularly (into a muscle). Frequent or high-dose injections of steroids can heighten the risk of fractures.

In the context of joint injections, which are commonly employed to alleviate inflammation in arthritic patients, the absorbed amount of the active drug is generally low. While occasional joint injections are unlikely to pose risks, many injections over time might adversely affect bone strength.

Steroid Inhalers

Inhaled steroids, often referred to as preventer inhalers, are generally considered less likely to lead to bone loss compared to oral body steroids in Canada. However, the impact of long-term use is still being researched. Some studies have indicated a potential correlation between prolonged inhaled steroid use and an increased likelihood of fractures, but it remains unclear whether steroids themselves are the cause. Factors like underlying lung disease, lifestyle choices (e.g., smoking or inactivity), and the necessity for occasional oral steroids complicate the assessment of inhaled steroids’ effects on bone health.

Steroid Creams

Topical steroid creams and gels typically do not affect bone health since only a minimal amount of the active substance enters the bloodstream in Canada. However, prolonged use or high doses may lead to significant absorption, raising the potential for side effects.

In summary, while oral body steroids can have implications for bone health, careful management and monitoring by healthcare professionals can help mitigate these risks in Canada.