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Prednisone Dangers...


Even Low Steroid Doses Can Be Trouble

Fractures tied to common arthritis, asthma drug
By Julia McNamee Neenan
HealthScout Reporter

MONDAY, Oct. 23 (HealthScout) -- Daily low doses of a commonly prescribed oral steroid, prednisone, can double your risk of hip fractures and cataracts, scientists reported today. Researchers have long known of the link between higher doses of oral steroids and dangerous side effects, but the new study shows the potential for side effects at much lower doses, says Dr. John B. Wong, an associate professor of medicine at Tufts-New England Medical Center in Boston.

The problem is that prednisone and other steroid medications are critical in managing diseases in which inflammation plays a painful role, Wong says.

"Low-dose steroids are used commonly in a number of diseases, including patients with asthma or rheumatoid arthritis," he says. Prednisone also is used to treat Crohn's disease and other inflammatory bowel disorders.

Wong stresses that people who are taking this medicine should not stop doing so based just on these new findings.

"If patients are worried about the long-term side effects, I'd encourage them to discuss it with their doctors," Wong says. "The benefits of the medicine might clearly outweigh the risks."

The study tracked the progress of 4,993 people with rheumatoid arthritis for 15 years, monitoring their medications and subsequent health.

Those who'd taken 5 milligrams to 10 milligrams of prednisone a day were twice as likely to break their hips and 2½ times as likely to develop cataracts as those who had taken no prednisone, the study says.

And those who'd taken the steroid at these low doses for three or more years were 3.2 times as likely to develop cataracts as those who had not taken prednisone, it says. Findings are being presented today in San Francisco at a meeting of the American College of Chest Physicians.

People with rheumatoid arthritis take prednisone orally, while people with asthma usually inhale the medication. But Wong says other tests have shown that the body absorbs the two forms of medicine similarly.

Prednisone is so commonly used that more than half of the participants in the study used the medication at one point or another, Wong says.

However, Dr. Jefrey Lieberman, director of the Arthritis Care Center in Atlanta, says the drug is used less frequently today than it was when Wong's study started in 1982. Lieberman estimates that just 10 percent of his patients use the drug at any one time.

The side effects of prednisone at higher doses have been known for some time, he says. So, while the medication was first seen as a miracle cure, today it's prescribed with more caution, Lieberman says.

About 2.1 million people in the United States are diagnosed with rheumatoid arthritis.

Prednisone doesn't affect the progress of the disease, "but nothing works better to reduce inflammation quickly than prednisone," Lieberman says. Doctors constantly are attempting to determine the "magic dose," or how many milligrams of the medication best help someone without bringing on side effects, he says.

Attempts to reach Schein Pharmaceuticals, which manufactures Prednisone, were unsuccessful.

What to Do

Lieberman says other oral steroids could be presumed to affect your hips and eyes as prednisone did in this study. These steroids, called corticosteroids, differ from anabolic steroids, which bodybuilders sometimes use to pack on muscle power.

If you and your doctor determine that prednisone or another oral steroid is useful for your health, despite its side effects, your doctor will want to monitor you closely, Wong says. In keeping an eye on the health of your bones, for example, and to prevent osteoporosis, your doctor will want to make sure you have enough vitamin D and calcium in your diet. If osteoporosis begins to develop, your doctor may prescribe hormone replacement therapy or another medication to beef up your bones.

Similarly, to protect against cataract formation, your doctor may recommend you shield your eyes from ultraviolet light exposure as much as possible, usually by wearing sunglasses.

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