Reducing joint inflammation keeps people with arthritis pain-free and mobile. It also preserves bone health – that is, if certain classes of anti-inflammatory and disease-modifying drugs are used. But when inflammation is brought down with corticosteroid drugs, bones may be harmed.
Corticosteroids, such as prednisone, make bones weak because they decrease the amount of calcium absorbed by the intestines, increase the amount excreted through the kidneys and can have a toxic effect on the cells that form bone.
Currently, the bisphosphonates are the standard treatment for corticosteroid-induced osteoporosis, but a study published in the New England Journal of Medicine in 2007 shows that for people with prednisone-induced osteoporosis who are at particularly high risk for fracture, using parathyroid hormone – a bone-formation agent called teriparatide injection (Forteo) – may be a good option. Parathyroid hormone is approved for treating women who develop osteoporosis due to a decline in estrogen after menopause, or for men whose osteoporosis is linked to a hormone deficiency.
In the study of 428 men and women, ages 22 to 89, whose osteoporosis was caused by taking prednisone for three months or longer, bone density of the half who received the daily injections increased by 7.2 percent – twice as much as it did in those who took the alendronate pills (3.4 percent). Those who received the injections also had fewer spine fractures, but, as a side effect, some had periodically elevated blood levels of calcium.