Prednisone and bone loss. I was diagnosed with PMR

I have been on prednisone since July. Started on 20 mg a day and, basically, never made it to less that 17.5 mg yet. I have no pain anywhere except my right hip and knee and sometimes in both groin areas. However I am very limited in my walking and movement and now must use a rollator walker. Had an X-ray of my right hip in July which was normal. Had the X-ray repeated in October which revealed total destruction of my right hip and I am now considered a candidate for a total hip replacement. I was not put on folic acid or any bone sparing medication when started on prednisone. I am interested in the opinions of this group as to whether the prednisone could have caused this damage in just 4 months.

Hi @elizabethjoan, I'm sorry to hear that you are now considered a candidate for a hip replacement. I don't think you are alone in your concerns about bone loss and taking prednisone. I'm not sure anyone can tell you for sure that taking prednisone at a level of 17.5 mg for four months caused the destruction of your hip. There are a lot of factors that play a part in degeneration of joints.

Teri @tsc started a discussion on how to avoid or prevent bone loss that may be helpful:
-- Use of Prednisone and Improvements in Bone Density:
https://connect.mayoclinic.org/discussion/use-of-prednisone-and-improvements-in-bone-density/
I have degenerative arthritis in my back, hip and knee joints. I've had my right knee replaced and my right hip doesn't hurt but it's not in very good shape so I'm trying to avoid having a hip replacement.

You mentioned starting the prednisone in July at 20 mg daily and haven't been lower than 17.5 mg. Assuming the doctor/rheumatologist diagnosed you with PMR, 4 months is a short time in a tapering schedule for PMR and each of us handle the pain differently. If you don't have any pain other than in the right hip, knee and groin area, maybe the bad hip is the source of the pain?

I haven’t… My dad (with PMR) takes alendronate tablets once a week, and despite all the warnings he tolerates it fine, no problems. His rheumatologist brought up different options, including Reclast, but he doesn’t have osteoporosis, so it wasn’t as urgent.

Hopefully you might hear from others who’ve tried Reclast. But if you’re not comfortable with it, do you think you could talk to your rheumatologist about other options that might be a fit? I remember besides alendronate and Reclast, an injection was an option. Just looked it up and it was Prolia.

Thanks for your reply. I can’t take alendronate as I have GERD, but I’ll talk to my doctor.

I have been off and on prednisone for 35 years and on low dose (2.5 to 5 mg) P for 10 years. My bone mineral density was normal or above normal for my age, 77, last October. Probably due to the expensive amount of exercise I get. I play tennis, singles, about 5 days a week.

This related discussion may also provide some helpful ideas:
— Use of Prednisone and Improvements in Bone Density:
https://connect.mayoclinic.org/discussion/use-of-prednisone-and-improvements-in-bone-density/

I have been diagnosed with severe Osteoporosis...could have knocked me over with a feather!
I've led a very active life, vegan (thought I was doing this well for calcium - lots of nuts/veges/fruit...perhaps I could have done this better...have an appointment with a dietitian to address how I can improve my diet).
Mother had a hip replacement after falling so suggestion is that it might be hereditary. I also breast fed my two children for 12 months (with intro to solids along the way of course).
Had to ask GP for a BMD test - I've read that after menopause/around 60 and a other indicators that a BMD would be appropriate - at the X-ray clinic the clinician asked me twice, "are you sure you've never had any fractures"?...none that I know, compression or otherwise. GP when he saw the results expressed surprise that they didn't perform a more comprehensive test (they did what he ordered, which I had to ask for) and said he was surprised that I hadn't incurred a fracture/s when I fell over and saw him some 2 years prior to BMD test.
How long had I had Osteoporosis...I don't know but I have read that Prednisone, long-term can lead to Osteoporosis.
My new GP liaised with my Rheumatologist and I've been told that, as I my calcium levels (I supplement) and VitD are good and that because I regularly exercise (walk on hard surfaces - about 4-6klm a day), and do regular weight-bearing exercises (eg. squats/dead-lifts/bicep curls/tricep dips...all carefully, with good form - I was, once upon a time a Personal Trainer) they don't see the need at the moment for me to go on bisphosphonates to address the Osteoporosis.
That is excellent news.
I wouldn't have gone on one anyway as the side-effects include the very things one needs at all costs to avoid...dizzines/falls ++++ ????????????? Side-affects read like a horror story, as does Prednisone, however one has to choose/compromise as suits your lifestyle and try, hard, to keep complying with lifestyle needs to try and beat this beast...it's hard work, isn't it!
I choose to exercise regularly, follow dietitians dietary advice including supplements I might need.
My calcium dosage as advised by my Rheumatologist is 1500mg/day...I have a very bland diet with lots of kale & broccoli which in all seriousness gives me a flatulence problem of MAMOTH proportions - I have to schedule appointments and diet to avoid offending anyone/losing friends...lol...no, it is serious but again one has to deal with how to manage ALL the complications of the disease.
I hope this has helped. Take care.

Oooh, to be brief in answer to your question...yes, I think it is possible

My two cents: My bones were 135% of a 40 year old 3 years ago. I was 78 yrs. old.
Then I struggled with 2.5 years of Medrol (Methylprednisolone, like Prednisone but slightly stronger) for PMR. I'm not off yet, at 5 mg/day.

Now I have osteopenia in my right hip. BTW had I also had almost 2 years of Methotrexate in an effort to get off the d...n Medrol. Elevated liver Enzymes kept me from ever achieving any results. Now I'm on Leflunomide, and hope for Kevzara eventually.

I have horrific skin damage from the steroid. And still have PMR at a moderate level.

Elaine

I'll add my experience. I started Prednisone 2 years ago. I had osteopenia, which means between 10 and 20% lower bone density than a young person. It had been very slowly dropping over time. My rheumatologist put me on Fosamax, calcium and vitamin D as soon as I started prednisone. He then tested my D level and it was low so I increased the dose. After a year on prednisone a new DEXA scan showed a 15% INCREASE in bone density. I'm now off the Fosamax since I'm down to 5mg prednisone. I didn't want to take it because that made 3 drugs that affect my GI tract (along with prednisone and methotrexate). Next year I'll get another scan and go back on Fosamax if I need to.

I have been on prednisone for PMR since Dec 2020. Started at 20 mg now down to 11 mg. I first had hip pain in Jan 2023 and I was sent to an orthopedic doctor who said it was my spine. I then went to pain management who said it was my spine and gave me a steroid injection which made my pain worse. Neither of these doctors xrayed my hip! The third spinal surgeon I saw did X-ray my hip and said it is the main cause of all my pain that it is pure bone on bone. I have much arthritis so who knows if prednisone played a part in destroying my hip or just arthritis. My recent dexa scan was normal. I am having total hip replacement in two weeks. Then we can see where the back pain is. A hip X-ray done in Feb 2023 showed slight osteo arthritis and the one in July 2023 showed total destruction. That was a fast decline in 5 months. If you can’t get answers keep trying different doctors. One was finally smart enough to x ray my hip. Best of luck to you. May we all be pain free.