More vitamin D needed if person is taking Glucocorticoids
Note: glucocorticoids are used to treat inflammation, adrenal insufficiency, allergic, inflammatory, and autoimmune disorders
They also cause immunosuppression - which should be offset by Vitamin D
Side effects mentioned in Wikipedia include
Immunodeficiency
Hyperglycemia
Increased skin fragility, easy bruising
Negative calcium balance due to reduced intestinal calcium absorption
Steroid-induced osteoporosis: reduced bone density (osteoporosis, osteonecrosis, higher fracture risk, slower fracture repair)
Weight gain due to increased visceral and truncal fat deposition (central obesity) and appetite stimulation
Hypercortisolemia with prolonged or excessive use (also known as, exogenous Cushing's syndrome)
Impaired memory and attention deficits
Adrenal insufficiency (if used for long time and stopped suddenly without a taper)
Muscle breakdown (proteolysis), weakness, reduced muscle mass and repair
Excitatory effect on central nervous system (euphoria, psychosis)
Anovulation, irregularity of menstrual periods
Growth failure, delayed puberty
Increased plasma amino acids, increased urea formation, negative nitrogen balance
Glaucoma due to increased ocular pressure
Cataracts
- many of which are associated with low vitamin D!
Bisphosphonates and glucocorticoid-induced osteoporosis: cons - June 2015
Endocrine. 2015 Jun 4. [Epub ahead of print]
Lems WF1, Saag K.
1Department of Rheumatology, VU University Medical Centre, 3A 64, Amsterdam, The Netherlands, [email protected].
During the use of glucocorticoids (GCs), both vertebral and nonvertebral fracture risk are increased, due to the direct and indirect negative effects of GCs on bone, muscles, and the activity of the underlying inflammatory diseases. Inhibition of bone formation and increased apoptosis of osteocytes play a consistent and crucial role in the pathogenesis of glucocorticoid-induced osteoporosis (GIO), while changes in bone resorption during GC-use are variable. To prevent fractures, important general measures include using the lowest possible dose of GCs, treating the underlying disease adequately, a healthy life style, adequate calcium and vitamin D supplementation , and regular exercise. Although it has been shown that bisphosphonates reduce vertebral fractures during the first 2 years of GC-treatment, there are no data on long-term use of bisphosphonates during GC-treatment. Of some concern in GIO, bisphosphonates reduce bone turnover, including bone formation, which is already downregulated by GCs. In contrast, the use of the anabolic agent teriparatide is more effective in reducing vertebral fractures than alendronate. In summary, bisphosphonates remain the first choice in the first two years of treatment in GC-treated patients with high fracture risk, but their long-term effects on bone quality and fracture risk reduction remain uncertain.
PMID: 26041376
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Oral Calcidiol Is More Effective Than Cholecalciferol Supplementation to Reach Adequate 25(OH)D Levels in Patients with Autoimmune Diseases Chronically Treated with Low Doses of Glucocorticoids: A "Real-Life" Study.
J Osteoporos. 2015;2015:729451. doi: 10.1155/2015/729451. Epub 2015 Jun 1.
Ortego-Jurado M1, Callejas-Rubio JL2, RĂos-Fernández R2, González-Moreno J3, González RamĂrez AR4, González-Gay MA5, Ortego-Centeno N2.
Glucocorticoids (GCs) are the cornerstone of the therapy in many autoimmune and inflammatory diseases. However, it is well known that their use is a double edged sword, as their beneficial effects are associated almost universally with unwanted effects, as, for example glucocorticoid-induced osteoporosis (GIO). Over the last years, several clinical practice guidelines emphasize the need of preventing bone mass loss and reduce the incidence of fractures associated with GC use. Calcium and vitamin D supplementation, as adjunctive therapy, are included in all the practice guidelines. However, no standard vitamin D dose has been established. Several studies with postmenopausal women show that maintaining the levels above 30-33 ng/mL help improve the response to bisphosphonates. It is unknown if the response is the same in GIO, but in the clinical practice the levels are maintained at around the same values. In this study we demonstrate that patients with autoimmune diseases, undergoing glucocorticoid therapy, often present suboptimal 25(OH)D levels. Patients with higher body mass index and those receiving higher doses of glucocorticoids are at increased risk of having lower levels of 25(OH)D. In these patients, calcidiol supplementations are more effective than cholecalciferol to reach adequate 25(OH)D levels.
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