Oral steroids (e.g., prednisolone, hydrocortisone, methylprednisolone (medrol) dosepak, etc.) are prescribed often, most commonly for inflammatory conditions, such as arthritis, bronchitis and asthma, inflammatory bowel diseases, muscle pain, allergies, and more. I have known for a long time about the complications and side effects associated with the long-term use of oral steroids (osteoporosis, weight gain, behavior changes, increase in blood pressure, etc.), so the general recommendation has been to take the minimum dose necessary for the shortest amount of time needed to treat the problem; however, a new study suggests I and my patients also have good reason to be concerned about short-term oral steroid side effects as well, even at fairly low doses.
Before I discuss the newest study, let’s review some other concerns I’ve addressed on this blog regarding oral steroids.
I’ve said it before, and I’ll say it again: steroids are bad news. While I’ve discussed the boatload of problems uncovered in studies on epidural steroids, I’ve also devoted a fair share to oral steroid side effects as well. Though most of the studies, until now, have focused on the complications of long-term steroid use.
I see otherwise young healthy patients who come to the clinic with Avascular Necrosis (AVN)/Osteonecrosis (ON) after having been on high dose oral steroids for minor acute conditions, such as an upper respiratory condition, which is tragic. I’ve covered studies confirming the extreme risks of Osteonecrosis with oral steroids, including one showing 20 times higher risk of Osteonecrosis in patients on these drugs. Oral steroids are an equal opportunity offender, as another study found evidence that oral steroids ate away at the bones of older women who’d been taking steroids for three months or more.
I recognize, of course, that there are certain serious conditions, such as asthma, for example, in which steroids like a prednisone inhaler are prescribed and absolutely necessary; however, the concern here are those oral steroids prescribed for much less life-threatening conditions, such as a simple upper respiratory infection, a flare up of sciatica, and even arthritis (see the alternatives section below). If for some reason you and your doctor feel you need to take oral steroids for a minor short-term problem, You may want to consider taking vitamin E, which has been shown to lower osteonecrosis risk in animal studies!
The new study included over 1.5 million adults and compared those who were taking a short-term prescription of oral steroids (defined by this study as 30 days or less) to those who were not taking steroids. Six days was the median duration of time subjects used the steroids, with 47% taking the heavily prescribed six-day Medrol (methylprednisolone) dosepak. Study authors concluded there was a significant increased risk for fractures, blood clots, and sepsis (a severe life-threatening infection) in the subjects who had short-term use of oral steroids, even at lower doses, compared to subjects who had not taken the drug.
How much did these risks go up?
-Sepsis by 530%
-Blood clot by 333%
-Fracture by 187%,
But are there alternatives? Yes, for example, for most patients who take a short course of oral steroids for sciatica, they can either be managed by oral anti-inflammatory supplements or a targeted epidural at the problem area using their own growth factors.
Curcumin, chondroitin, glucosamine, and fish oil are supplements that have been shown to be very beneficial in treating inflammation.
The upshot? The biggest take home message here is that even a short course of oral steroids like a Medrol dosepak can dramatically increase the risk for life changing side effects. Given how frequently these things are prescribed (usually by family physicians), there are likely thousands of cases of preventable fractures, blood clots, and sepsis every year. Our biggest issue is what I call the “Internal Medicine” mentality, meaning that some physicians aren’t trained how to diagnose where a musculoskeletal problem originates, so they just throw medications at it. Hopefully, physicians who prescribe these medications for simple things like a pinched nerve will now think twice.
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…