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Steroid-induced osteoporosis treatment
1) My mother has Sjogrens (dry mouth) and is on HCQ since 2007.
2) Her mother died of stomach cancer in 2006.
3) January 2011, she was diagnosed with ITP. Started steroid (prednisolone). Stopped steroid after 8 months. Platelet count has been normal since then. (8 months was doctor’s recommendation.)
4) 2011 August, she fell on escalator and fractured wrist bone immediately. Fracture healed in 4 to 5 weeks.  Due to trauma, she suffered DVT and due to warfarin overdosage(lab mistake in recommended dosage!) suffered skin necrosis which led to skin grafting(operation).
5) She has tolerated well Risofos – a risedronate, from April 2011 to Sep 2011(while on steroids) and again April 2012 to Sep 2012 (not on steroids). BMD was checked after 6 months of stopping Risofos.
6) In 2012, checked BMD owing to terrible back pain. Results showed steroid-induced osteoporosis. Spine T score of -3.7, Z-score = -2.4. Femur T-score = -2.3, Z-score = -1.9
7) Presently taking calcirol sachet 60,000IU once a month, Vit D(500iu daily) and Ca(1250mg daily) along with good diet, lots of sunshine, active lifestyle.  Vitmain D levels = 28 ng/ml.
8) P1np marker is 34.76ng/ml.

Concerns

1) For steroid induced osteoporosis and her medical history which is recommended: Forteo or Biphosphonate?  
2) She has never received any radiation on bones, but her mother died of stomach cancer. Does that put her at an increased risk of osteosarcoma?  We are aware that only 2/250,000 patients thus far have had osteosarcoma.
3) Osteonecrosis – Because of Sjogrens, she has lost most of her teeth and is on dentures. Is she at increased risk of osteonecrosis?

Thanks. Concerned....
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1711789 tn?1361311607
Hi there!

1. There is no absolute indication of contraindication for using either, though the risks of each would need to be well calculated against the risk and the decision is best taken by the treating doctor.
2. A family history of stomach does not increase the risk of osteosarcoma.
3. There may be a slight increased risk of osteonecrosis owing to sjogrens and steroid use, with the use of medications.
Hope the information is helpful.

Take care!
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3112530 tn?1434035633
I have had MANY steroid injections, nerve blocks and more procedures including surgery, metal implants and removal of metal implants due to nerve impingement. I am a 60 yr old male with a family history of cancer. All my family died from cancer but I do not have any yet.
Due to the continued steroid injections, I developed osteoporosis. My bone scan was not good. Could not figure out why everything I tried was not working and now I know why I have pain. Currently seeing a new pain management doctor. Best advise I received from him was to stop the steroid injections, they lead to bone deterioration.
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