Prednisone and Your Bones: Harvard Answers Your Top Questions

Understanding the Impact of Prednisone on Bone Health

Prednisone, a commonly prescribed glucocorticoid, plays a vital role in managing various inflammatory and autoimmune conditions. However, one of its most serious and under-discussed side effects is its detrimental impact on bone health. In a recent survey of 250 respondents, bone loss was reported as a top concern for those taking prednisone.

This guide explores how prednisone affects bone health and outlines effective strategies to protect and strengthen bones during treatment.

Watch now!

How Prednisone Harms Bone Health

Prednisone disrupts the natural balance between bone formation and bone breakdown. Specifically:

Increased Bone Resorption: Prednisone stimulates osteoclasts—the cells that break down bone tissue.
Suppressed Bone Formation: At the same time, it inhibits osteoblasts, the cells responsible for building new bone.
Reduced Calcium Absorption: Prednisone decreases the absorption of calcium from the gut, causing the body to draw calcium from bones to maintain normal blood levels.

According to Dr. Naomi Patel, a professor at Harvard, taking more than 7.5 mg of prednisone daily—especially for prolonged periods—significantly raises the risk of osteoporosis and fractures. Even lower doses, when taken long-term, can lead to bone loss, particularly after three months of use, with the effects lasting at least a year.

Practical Strategies to Prevent Bone Loss

To counteract the impact of prednisone on bones, consider the following evidence-based strategies:

1. Quit Smoking

Smoking is a known risk factor for osteoporosis. Quitting can significantly reduce your risk.

2. Limit Alcohol Intake

Excessive alcohol consumption contributes to bone loss and should be avoided or minimized.

3. Supplement Wisely

Diet alone often falls short in providing essential bone-supporting nutrients. Look for supplements that contain:

These nutrients work synergistically to promote bone density and reduce fracture risk.

4. Prioritize Weight-Bearing Exercise

Activities like walking, resistance training, and yoga not only strengthen bones but also:

Decrease inflammation
Improve cardiovascular health
Help regulate blood pressure
Boost mood and reduce anxiety—common side effects of prednisone

What If You Already Have Osteoporosis?

If you’ve been diagnosed with osteoporosis or are at high risk:

Discuss Treatment Options: Medications such as bisphosphonates (e.g., Fosamax) are effective and often safer compared to the ongoing risks of prednisone.
Understand the Risks and Benefits: While bisphosphonates carry some risks, the dangers of untreated bone loss due to prednisone are typically more severe.
Evaluate Your Risk: Ask your healthcare provider about a DEXA scan to assess bone density and consider using the FRAX calculator to determine your 10-year fracture risk.

Beyond Bone Health: Additional Prednisone Risks

Prednisone use isn’t limited to bone concerns. It’s also associated with increased risks for:

To help manage these and other complications, a comprehensive Prednisone Checklist is available for download. This tool consolidates all strategies discussed and offers additional health tips for those on glucocorticoids.

Ensuring Stronger Bones During Prednisone Use

If you’re taking prednisone, proactive bone health management is essential. Prioritize lifestyle habits like:

Avoiding smoking and alcohol
Taking appropriate supplements
Staying physically active

For those at very high risk—such as individuals taking 30 mg of prednisone daily for over 30 days—anabolic treatments may also be considered.

By implementing these strategies, you can significantly reduce your risk of osteoporosis and improve your long-term well-being while on prednisone therapy.