Rheumatoid Arthritis and prednisone and bone density and osteoporosis

lumbar spine x-ray

Lumbar Spine Right X-Ray MarkerI have been on a moderate dose of prednisone for around 3.5 to 4 years now.  I guess I would average 15mg per day over that time.  I have bursts where I go up to 30mg and feel pretty darn good (apart from the anxiety and the sweats and the mania) and then I try to taper off.

I can’t get off prednisone.

I’m pretty sure I have secondary adrenal insufficiency now, from long term use.

My blood sugar is too high from prednisone  use.

I have glaucoma, but it’s currently under control.

I have cataracts from prednisone use.

My skin has thinned from prednisone use.

I have high blood pressure…prednisone probably contributes, but that could be from any one of a number of medications I take.

Anyway, prednisone has loads of side effects. One of the biggest concerns is always osteoporosis, or loss of bone density.  Osteporosis is generally irreversible, and leaves a person very vulnerable to fractures.  Rheumatoid arthritis itself raises your risk of osteoporosis, but prednisone is notorious for causing bone density loss.

My last bone density or DXA scan was two years ago.  At that time I had been on lots of high dose bursts.  My doctors were very concerned.

The scan came back abnormal. Very abnormal. But for once it was the opposite way. It was amazingly good.  My bone density was about 7x more dense than an average person of my age.  It caused quite a stir. My GP did some research and could find no reason, nor any reason to worry about this. It appears my genetics just *knew* I would need to be on prednisone long term, and gave me the bones to deal with it.

I’m quite used to be the ‘unusual’ patient. I get that all the time.  But its not usually a good thing. This time it was.  And I had a little party and did my happy dance.  Prednisone hadn’t done its thing to my eyes, and bloody sugar and blood pressure at that point. I felt like I’d been given a free ride on the prednisone train!

Anyway, I was looking forward to seeing what, two years down the track, my bone density looked like.

A bone densomitry scan is a simple, painless scan, with no preparation required. It measures the density of your spine and the femoral head, at the hip.

I won’t keep you in suspense.   My spine was exactly the same. I mean, EXACTLY the same. The technician was laughing, because I had just finished explaining that my bones were unusually dense.  She said she’d never seen anything like it. Nor had she ever had someone have exactly the same reading twice, to the third decimal place.

The reading at my hip was different – a 5% bone loss.  That’s pretty normal. And again, I’m starting with such dense bones, it’s not at all scary. Especially considering the doses of prednisone I am taking.

Why do I have such dense bones?  Mostly some good genetic luck there. BUT it has to be said I have done weight bearing exercise all my life.  Even now, I lift light weights and do yoga/pilates.  Weight bearing exercise keeps your bones strong.  I also ensure I get plenty of calcium and take vitamin D supplements.   All of those things help.

So, in terms of osteoporosis at least, I am have no need to worry.  In fact I’m freaking Wolverine.  I was born for prednisone.  My doctors will be pleased.  And I feel justified in my decision not to even try taper down before Christmas.  In the New Year I will reassess everything.

But for now, I’m just going to enjoy a bit of good news.


  1. You don’t want to stay on prednisone long term as it can cause an enlarged heart, in fact it played a major role in a family member’s heart problem which ended up sadly killing her in her 50’s, back then none of knew about the long term effects and the doctor never checked, never warned about anything like that was possible.

    I know it’s sometimes easier said than done trying to hang in there when dealing with that kind of pain but remember there’s always hope, there’s a lot more knowledge today. I hope this will encourage you.


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