Steroid Pill Side Effects: Older Women and Oral Steroids are a Bad Mix

Some older women with inflammatory diseases find themselves on oral steroids. These potent drugs reduce swelling, but there are also a bevy of steroid pill side effects. Now a recent study shows that just a few months on these drugs literally eats away at the bone architecture of these women.

Oral corticosteroid pills (not bodybuilding steroids) are powerful anti-iflammatory drugs that are usually begun when a patient has an inflammatory disease. As an example, my own mother was placed on them to treat polymyalgia rheumatica (PMR). Other problems like temporal arteritis or flares of rheumatoid arthritis are often treated with oral steroids. I’ve also seen women placed on these drugs to regulate their cortisol levels as an age management strategy.

We’ve known for some time that steroid pills taken by mouth are bad news. For example, in one study, even short term use of steroids dramatically increased the risk of a horrible bone disease known as osteonecrosis. In addition, other research has shown that even a single epidural steroid injection given to older women for low back pain causes bone loss and an increased fracture risk.

The recent study used precise new imaging methods to look at the bone structure of 30 women placed on oral steroids for three months or longer. In particular, a high resolution CT scan was used to observe the micro architecture of the women’s bones and compare that to 60 control patients who didn’t take steroids. What’s fascinating was the standard gross metric called a DEXA scan was not accurate enough to show any differences between the women. However, the more sophisticated measures did show huge and scary changes. The women on steroids literally had evidence that their bones were being eaten away and rearranged by the steroids.

The upshot? Steroids are bad news for older women. This study is important in that many other studies that have looked at this issue and declared steroids safe have used a DEXA scan to look for differences, which in this study wasn’t sensitive enough to detect obvious changes seen on more sophisticated tests. This makes one wonder how many studies on oral steroids and bone loss out there have erroneous conclusions!

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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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