Steroid Induced Bone Loss
We all know that corticosteroids (steroids), both inhaled and oral have unwanted side effects. One of the side effects that in my experience asthma patients aren't aware of is the possibility of weakened/brittle bones. When people think of brittle bones, they often think of the elderly. While it is definitely more common for the elderly to have brittle bones, asthmatics who have been on long term inhaled/oral corticosteroids are at risk as well.
Corticosteroids have a major effect on the metabolism of calcium which can lead to bone loss, osteopenia, osteoporosis and broken bones. They both suppress bone formation and promote resorption. While oral steroids are more likely to cause these bone loss issues, inhaled steroids over time in high doses can also lead to bone loss.
For the majority of asthmatics, some form of steroid medication (whether that be inhaled or oral) is a daily necessity. You might have heard of the S.E.T. acronym when referring to asthma and the characteristics associated with it. SET stands for Swelling, Excess mucus and Tightening. Steroids work by reducing inflammation as well as production of mucus and swelling. Steroid inhalers do more than what your rescue inhaler (such as albuterol or xopenex) is capable of which is necessary for so many asthmatics. Rescue inhalers are bronchodilators which do exactly that, they dilate the airways. But they do not help with the inflammation which is what is the main issue with asthma.
There are some steps you can take to help lessen and monitor the potential bone loss from steroid use. Maintaining a healthy diet, regular physical exercise (as much as you are able to do on the recommendation of your doctor), not smoking, and limiting alcohol consumption are important.
Annual bone density scans (DEXA - which stands for Dual-Energy X-Ray Absorption) are recommended to be done annually to help monitor your bone density. This is a test your doctor can order. It's a quick and painless X-ray of sorts, which actually has less radiation than a traditional chest X-ray. What it does is measures how many grams of calcium and other bone minerals are in a specific part of bone. The higher the bone mineral count means that your bones are more dense, and therefore they are stronger and less likely to break whereas if the bone mineral content is low, your bones have a less mineral count and are more likely to break.
For me personally, I have a DEXA scan done every year. My bone density is in the osteopenia category from all of the years of both oral and inhaled steroid use necessary to keep my asthma under control. I'm not quite in the full blown Osteoporosis category and my doctor and I are taking steps to hopefully prevent my bones from weakening any further. I take daily calcium supplements and stay on top of my asthma triggers to help avoid any major asthma flare ups that would require me to end up on a high dose steroid burst. Of course it is very important to note that you should never take or increase the dose of any supplements such as calcium without your doctors approval or recommendation.
It is also important to mention that everyone has different effects from steroid asthma mediation. Not everyone will have bone loss issues and it will vary from person to person as far as the degree to which it may or may not be occurring. This is why it is important to have an open dialogue with your doctor about having monitoring done and deciding if calcium supplements are needed.
We all need to breathe, and unfortunately often times that means taking a daily inhaled or oral steroid which over time can lead to weakened bones. If you haven't already done so, talk with your doctor about it the next time you see them.
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