My question is about secondary osteoporosis. I have adrenal insufficency since birth and have been taking prescribed hydrocortisone my whole life. I am now 28 and have only recently found out that prolonged use of these steroids can cause osteoporosis.
Should I immediately start taking Calcium & Vitamin D supplements to curb the further onset of this disease?? And, is there a high chance that after so many years I already have a certain percentage of bone loss??
Yes, it would probably be a good idea for you to be on calcium and vitamin D supplements, as you are a set up for osteoporosis and as a result, at risk for future fractures of the hip, spine, and distal radius (wrist).
You should probably have a DEXA scan done to determine the status of your bone density. Then depending upon the results, your calcium and vitamin D should be optimized.
If the results of the density test puts you at significant risk for fracture, you may even need to be placed on medicine to help rebuild bone. That is something that you would need to discuss with your endocrinologist.
The recommended daily requirements for calcium and vitamin D are listed below. With your medical history, you should probably be taking the amounts required for women who are postmenopausal.
The best place to get your needed vitamin D is from natural sunlight. Depending upon age, gender, and skin coloration, a person can produce up to 1000 IU of vitamin D, by having the sun shine on the face and arms for anywhere from 10 to 30 minutes. Older persons, females, and persons with darker colored skin need longer times in the sun to produce the needed vitamin D.
If you have been told to take a vitamin D supplement, a dose between 800-1000 International Units (IU) per day is safe and potent. Older patients should take the 800-1000 IU/day dose. Almost all multivitamins contain 400 IU/day. Also, many vitamin D supplements can be bought at most drug stores, food stores, and health food stores. Many calcium supplements also contain vitamin D in the right amount.
The following is a summary of an article about osteoporosis from AI. As noted in the last paragraph, it is also important that you eat a well balanced diet and participate in weight bearing exercise on a regular basis. One of the best weight bearing activities is walking. If you can jog, that is even better. Doing light weight lifting will help build bone. Though swimming is great for cardiovascular fitness, it is not very good for the prevention of osteoporosis.
The bones of patients with osteoporosis are normal in mineral content, just low in actual bone mass. As opposed to osteomalacia which is a bone disorder in which the mineral content of the bone is abnormal. So, osteoporotic bone is actually normal bone, just in not enough amounts. So, it will respond to stresses the same way that other bone will. This is known as Wolff's Law: Bone will respond to the stresses applied to it.
This is why weight lifters and people who do heavy manual labor have strong, stout bone. And the reverse, patients who do not stress their bones (age, injury, space flight) can develop osteoporosis.
Others things which affect bone metabolism are nicotine and alcohol. Patients are advised to stop smoking and limit their intake of alcohol.
ARE ADULTS TAKING CORTICOSTEROIDS FOR ADRENAL INSUGGICIENCY AT RISK OF OSTEOPOROSIS?
Publisher: North West Medicines Information Centre
Date published: 01/01/2011 10:21
Review date: 31/01/2013 10:00
by: Joanne McEntee
* Evidence from observational studies indicates that some adults taking corticosteroids for adrenal insufficiency (AI) have decreased bone mineral density (BMD). Two prospective studies reported that corticosteroid replacement therapy causes a dose-dependent reduction in serum levels of osteocalcin, a surrogate marker for bone formation. The risk of bone density loss may be influenced by cumulative or daily corticosteroid dose and co-existent hormone imbalances.
* Accurate replacement of physiological levels of cortisol is impossible with currently available corticosteroids. There is also no objective method of monitoring the accuracy of replacement in order to avoid over- or under-treatment.
* The traditionally recommended dose of hydrocortisone of 20 to 30mg daily may be too high for many patients. New techniques for measuring cortisol production indicate that the rate is much lower than previously estimated and most adult patients can be treated successfully with 15 to 20mg daily (or 10 to 12mg/m2/day).
* Adults with AI who have been receiving daily hydrocortisone doses higher than 25mg (or equivalent) should be considered to have a clinical risk factor for fracture, and their ten year major fracture risk should be assessed and managed as recommended in national osteoporosis guidelines. In all patients with AI, calcium and vitamin D intake should be optimised and weight bearing exercise and a well balanced diet encouraged; they should be advised to stop smoking and limit their alcohol intake.