Vitamin D Deficiency
And
Steroid Use
Physicians often prescribe oral steroids to treat a number of chronic diseases such as asthma, arthritis and ulcerative colitis, to name just a few. Many patients receive epidural shots of steroids for chronic low back pain.
Most people, including many physicians, don’t realize the devastating effects of steroids on vitamin D level in the body. Steroids pretty much eat away your vitamin D . Most people are low in vitamin D to start with. Steroid use further lowers their vitamin D level. These patients then suffer the consequences of vitamin D deficiency and develop severe muscle weakness and osteoporosis.
In addition, steroids directly affect the muscles and bones, worsening muscle weakness and osteoporosis. Muscle weakness primarily affects the muscles around the hips and thighs, causing difficulty in standing and walking. Consequently, these patients can easily fall. With their bones already weakened due to steroid-induced osteoporosis, they easily break their hip or vertebra in the back. A hip fracture further impairs mobility and a fracture of the vertebra causes incapacitating back pain.
Steroids Antagonize The Effects of Vitamin D
Steroids (even inhaled steroids) antagonize the effects of vitamin D. For example, in bone , vitamin D enhances bone formation by stimulating specialized cells, (osteoblasts), increasing calcium absorption from the intestines and preventing secondary hyperparathyroidism. Steroids do exactly the opposite: they have an inhibitory effect on osteoblasts, decrease calcium absorption from the intestines, increase calcium wasting from the kidneys and cause secondary hyperparathyroidism. In this way, steroids cause rapid bone loss (osteoporosis).
In addition to bone, some of the other opposing effects of vitamin D and steroids are as follows:
It is pretty obvious that steroids antagonize the effects of vitamin D.
What Is The Mechanism?
One known mechanism is that steroids alter the vitamin D receptor. Steroids also cause an increase in obesity and consequently, decrease the available circulating vitamin D. That’s why there are such widespread clinical findings of vitamin D deficiency in people taking steroids.
Could there be other mechanisms? Probably yes and we will learn about them as more and more researchers devote their efforts to this non-profit, non-glamorous field of medicine. However, from a clinical standpoint, the message is very clear. Steroids rob you of the beneficial effects of vitamin D. It has been shown that in a brief duration of 5 days, steroid use causes an elevation in parathyroid hormone level and an increase in calcium wasting in the urine.
Therefore, I recommend my patients to double or even triple their dose of vitamin D while they take steroids, provided they don’t have any history of kidney stones. No drug available today effectively treats steroid-induced osteoporosis. Here is one situation where prevention is your best treatment. Your best defense is a good dose of vitamin D. Unfortunately, many physicians don’t check vitamin D level, but immediately prescribe an anti-osteoporosis drug, such as Fosamax (alendronate), Actonel (Risedronate), Boniva (Ibandronate), or Prolia ((denosumab)), which doesn’t work effectively in steroid-induced osteoporosis. Beware! Next time someone puts you on a steroid, you must increase your daily dose of vitamin D. You’ll save your bones and avoid a lot of misery in the years to come.