ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Tuesday, February 4, 1997 TAG: 9702040124
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: Personal Health
SOURCE: JANE BRODY
Steve Tim of Brooklyn, N.Y., is among millions of Americans whose life, or quality of life, depends on continuous treatment with a steroid drug that unfortunately can cause osteoporosis.
Tim has a complicated autoimmune disorder that is treated with prednisone, a corticosteroid he must take daily to suppress the runaway immune system that is attacking his blood vessels, joints and bone marrow.
But while prednisone is protecting those vital body parts, it can also be eating away at Tim's bones. To help protect those bones from otherwise inevitable decay and possible fractures, Tim's rheumatologist told him to take daily supplements of calcium and vitamin D.
According to experts at the American College of Rheumatology, millions of others who must take steroid medications for prolonged periods are unaware of the risk to their bones and are not taking appropriate preventive measures.
Without proper protection, within the first six months of corticosteroid therapy, a person can lose 10 percent to 20 percent of bone mass. One in four of these people can expect to suffer a fracture as a result. Unlike osteoporosis associated with aging, steroid-induced osteoporosis can occur at any age, even in children.
The problem
More than 30 million Americans have disorders that may require treatment with corticosteroids. These drugs are extraordinarily helpful in suppressing the symptoms of a broad spectrum of diseases.
Steroids are essential to the treatment of many chronic inflammatory and autoimmune diseases, including chronic severe asthma, rheumatoid arthritis and other connective tissue diseases, chronic obstructive lung disease, inflammatory bowel disease, lupus and multiple sclerosis. Transplant patients usually depend on steroids to prevent rejection of the transplanted tissue. Steroids are also often used for shorter periods to treat acute inflammation and severe allergic reactions.
The drugs can be taken by mouth, injection or inhalation or they can be incorporated into drops or applied topically in a lotion or cream. They typically impair bone health only when taken orally or by injection on a regular basis. But while it was long thought that only high doses of steroids were a problem, more recent studies have shown that chronic use of low oral doses - as little as 7.5 milligrams a day - can also cause gradual bone loss.
Steroids hurt bones in a number of ways. They interfere with calcium, reducing the amount of calcium the body absorbs from foods and increasing the loss of calcium through the kidneys. This lowers the level of calcium in the blood, a situation the body must instantly correct by releasing calcium stored in the bones.
Steroids also cause bone breakdown directly. Although it may appear solid, bone is really a tissue that is constantly being broken down and built up. Steroids stimulate the cells that break down bone, and inhibit cells that build new bone. As a result, buildup of bone cannot keep up with breakdown.
Prevention, treatment
Last fall, the American College of Rheumatology issued guidelines to help prevent osteoporosis in patients who get long-term steroid treatment. Although rheumatologists should be well schooled in the problem and how to cope with it, the college noted that many patients using steroids were under the care of primary-care doctors who might be unaware of the hazard or what to do about it. The college urged doctors to use topical or inhaled steroid preparations wherever feasible and to always prescribe the lowest effective dose. The guidelines cautioned that although low doses of inhaled steroids are not a problem, high doses can result in bone loss.
These are the guidelines:
Step one. Either before or at the very start of steroid therapy, patients should be given a bone density test, especially of the lower spine and the neck of the thigh bone near where it meets the pelvis. This test should be repeated every six to 12 months to monitor the effectiveness of preventive measures and, if necessary, to modify the course of treatment.
Step two. Everyone who must take corticosteroids should consume at least 1,500 milligrams of calcium and 800 international units of vitamin D a day, either through diet or supplements. Vitamin D is needed to enhance the body's ability to absorb calcium and use it to build bone.
Step three. Those on steroids should be especially diligent about adhering to practices that can prevent bone loss and avoiding those that encourage it. Thus, patients should not smoke or drink more than moderate amounts of alcohol and should be sure to get regular weight-bearing exercise, preferably for 30 to 60 minutes a day. Useful activities include walking, running, dancing, strength training and cycling.
Step four. Women at or past menopause should, if possible, be on hormone replacement therapy. And women who have not yet reached menopause whose periods become irregular or stop while on steroids should take oral contraceptives unless there is a medical reason for not taking them. Men on steroids should have their testosterone level measured and, if found to be low, given testosterone replacement.
Step five. Patients on steroids should be examined to determine their risk of falls. This would include an assessment of balance, muscle strength, visual acuity and depth perception. Wherever possible, corrections should be made if problems are found. Patients should make a thorough examination of their homes and correct situations that might result in a fall. This includes eliminating scatter rugs and any obstacles between the bedroom and bathroom, installing night lights and putting support bars in the bathroom.
LENGTH: Medium: 100 linesby CNB