Oral Steroids Quickly Increase Your Risk of Fracture
However, Johnston says the jury is still out on the need to prescribe bisphosphonates for everyone taking steroids because "everybody doesn't get fractures."
The authors of the study, as well as Johnston and Manolagas, say the most puzzling aspect of the new finding is the speed at which the fracture risk increases. Manolagas tells WebMD that three months is too short a time for bone mineral density to significantly decrease. In his editorial, he suggests that the steroids may kill osteocytes, the most common type of bone cells. This cell death, called apoptosis, may increase the fracture risk, he says.
Johnston says that Manolagas may be on the right track but he says he doubts that the cell death theory can explain "the finding that fracture risk can change so quickly." He says the answer may lie not in total bone mineral density loss but "in where you lose it and the site at which it is replaced."
Just three month's worth of oral steroids, which are commonly prescribed to patients with asthma and disorders of the joints and bowels, increased chances of sustaining fractures by 70%. The large European study shows these fractures can happen much faster than experts have expected.
When the oral steroids are stopped, the risk decreases at a similarly rapid rate.
Observers note treatment for osteoporosis should be included with oral steroid therapy, but they don't agree when bone protection should begin, since not everyone gets fractures. Doctors also are unsure of why the risk of fracture increases so quickly.