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RE: [IP] RE: Steroids



Wow, there's more of us on here than I realized.

 I strongly agree -- a DEXA-scan (bone density test, not the cheap ones that
look at the wrist, but
the big machines that look at your hip & spine), every two years.

 Every year is probably a waste of money in most cases -- the changes aren't
generally big enough to
be statistically signifcant. You should get it on the same machine if possible.

 On theoretical grounds, prednisone should be more of an issue than
hydrocortisone, because of its
 longer action. The cycles from low to high levels and back have a significant
role in the natural
bone metabolism.

 The only study available, the Dutch Addison's study showed a
statistically-significant increase in
 osteoporosis in men, only, and linked it to over-replacement. The current
estimates on replacement
 doses run on the order of 15 mg/day hydrocortisone or 3.75 mg/day prednisone,
but because of the
 non-physiologic nature of oral dosing, I don't know many who are happy at that
dosage range.
 Certainly I was not! (And they didn't adjust it for my size, which compounded
the problem). But 30
 mg/day of hydrocortisone or 7.5 mg/day of prednisone, which used to be the
norm, is in fact
generally overreplacement.

 Note that this is a lack of evidence of a problem with osteoporosis in women,
not evidence of a lack
 of problem. But it does seem that for most individuals, being a post-menoposal
woman is a much
larger risk than steroid replacement at appropriate doses.

 Other endocrine factors can contribute to osteoporosis, such as hyperthyroidism
(from Grave's or
over-replacment), hyper- or hypoparathyroidism, maladsorbtion syndromes, etc.

 I believe that a sustained lack of cortisol is bad for bone quality, as well.
Healthy bone requires
 turnover -- a balance between tearing down old bone and laying down new bone. I
suspect that may
 have contributed to my multiple rib fractures (from coughing) and my broken hip
-- all before going
 on replacement steroids. But since we don't have any non-destructive way of
measuring bone quality,
this will remain conjecture...

 Anyway, the NADF recommends supplementation with calcium and vitamin D. I
recommend calcium citrate
with vitamin D3; I specifically take Citrical + D.

 Weight-bearing exercise is another thing you can do to help prevent
osteoporosis. Hormone
 replacement therapay is another option. That is one of the reasons I replace
testosterone and DHEA.
 My testosterone was low and my DHEA-S was non-existant. But it remains
speculative that these will
 help; the benefits of estrogen replacement is much more clear-cut. (But DHEA
does convert locally I
 tissues to estrogen, so it's not an unreasonable speculation). But I found that
it has a significant
 benefit for me in mood and sexual health. (But that's going from none to
normal; I don't recommend
 people with normal levels taking it, despite it being over-the-counter in the
US!)

 In my opinion, if you never need to increase your dosage for minor stresses or
illness, then
 probably your daily dose is a bit too high. If you have to do it very
frequently, it may be too low,
 or your dosing schedule may be not be a close enough match to the daily
cortisol cycle, which peaks
 in the early AM just before arising, and declines to very low levels overnight.
It takes
 experimentation to find the optimal dosing for you, and this is something no
doctor can really do
 for you. Just like diabetes. (But do keep your doctor in the loop in your
experimentation. Work as a
team).

The Dutch study: http://www.annals.org/cgi/content/full/120/3/207
The NADF Q&A: http://www.medhelp.org/nadf/diseases/addisonsqa.htm#osteoporosis

-----Original Message-----
 From: email @ redacted
[mailto:email @ redacted] On Behalf Of
jspock @over-the-rainbow.com
Sent: Wednesday, July 19, 2006 18:15
I've been taking Prednisone for over ten years for Addison's, and even 
though mine is also a maintenance dose, I have severe osteoporosis from it.  
You should ask your doc about a bone density test, just to be sure.
.
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