Monday, August 15, 2011

Density Decrease

I've written several times before about my friend, prednisone. While I've lamented the fact that it's major side effect for me seems to be the irresistible need to plant my face squarely in the middle of a large chocolate cake, all in all I've tolerated taking this medication long - term pretty well. When I was first diagnosed with psoriatic arthritis, my rheumatologist commented that I probably would have had much more severe and earlier symptoms if I had not already been on prednisone.

I can't imagine what that might have felt like. Ouch.

So, aside from living day to day with either Oreo or chocolate cake or various flavors of pie crumbs goobered down my front, every morning I slug down that little white pill without reservations.

Until Saturday, after I opened the mail. A slim white envelope addressed to me from my clinic contained the results of a bone density test. My doctor had highlighted the results which said: Significant bone mineral density decrease in the spine and hip regions. 10-year fracture probability for major osteoporotic fracture: 9%. Risk factors: Age, gender, glucocorticoid use. He had scribbled a note that we would discuss this at our upcoming appointment.

Well, dang. If I have to lose a significant amount of density of something, why can't it be adipose tissue? Or shoe size?

I began madly clicking away on Google Scholar. As expected, I found numerous studies confirming the decrease in bone density related to corticosteroid usage. But I was surprised to see this study, which concluded:
.....patients treated with prednisone ≥ 5 mg/day, combined treatment with MTX and prednisone was associated with greater bone loss in the lumbar spine than treatment with prednisone without MTX.
MTX in this study is methotrexate, which I am taking weekly along with my daily prednisone. Zoiks. A double whammy to my bones.

I have always considered myself to have strong and healthy bones largely due to my childhood on a dairy farm, which meant consuming lots of fresh milk along with living a very physically exerting and active lifestyle. My previous bone density exams over the last ten years have been perfectly normal.

It will be very interesting to hear what my doctor recommends after reading this report. And although I already am supplementing with vitamin D, and can't take calcium supplements since I have a yukky painful history of kidney stones, I predict some kind of medication regime change appearing soon.

Stay tuned.


annie said...

So, apart from all your other worries and problems, now you have to worry about some kind of bone fracture! You have to research because there were studies done (I forget which supplement it was) that actually brought on the fractures, after women had been on this calcium/bone supplement for some time.There's always something....

ShEiLa said...

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Christine said...

Ugh. Damn prednisone! I am on and off it all the time as well for Sjogren's and I worry about the long term effects. Trying to get off of it. I had lost 58 lbs. with a lot of hard work and immediately put 10 lbs. back on with this last round of prednisone. My last bone density was normal thank god but I am 40 so I do think long term. Hang in there!rehyp

Dana said...

With a history of kidney stones and bone density decrease, make sure that doctor does a blood calcium test and considers the possibility of hyperparathyroidism. Good luck and thanks for the wonderful blog!

Darlene said...

My brother is on prednisone, along with a handful of other drugs, after a kidney transplant. Not taking the drug can mean rejection and dialysis or even death, taking it means moon face and tremors and bone loss...

It's not easy to find the right combination, and all drugs have side effects. Catch 22, indeed.

I hope your doctor can find a balance for you!

Julia Oleinik said...

Hi Dana - Yep, I thought about hyperparathyroidism too but my serum Ca has been normal and is checked routinely.

Good point, Darlene - as a retired dialysis RN I can appreciate the dilemma that your brother faces when balancing drug risks and benefits vs transplant rejection. Not fun.