Does hydrocortisone cause osteoporosis?

Hi Dr T-- I just found out I have osteoporosis at age 58.-- and have been for 3 years and two months on 10 mg of Hydrocortisone. My MD is a fan of the low dose HC therapy, and has me on other supportive measures such as DHEA and progesterone and now Vit D. I see you have quite a bit on your site about safe uses of HC, and wonder if you can cite some reasons why the osteoporosis might NOT be due to the 10 mg of HC as the HMO MD's say. I am a Weston Price fan and do everything right-- bone broth, cod liver oil-- high vitamin butter oil w/ vit K-- all the healthy fats-- and NO poor quality foods. I do yoga and pilates and get good quality sleep. My adrenals have been exhausted for 20 years-- due I think to undiagnosed sleep apnea. Everything points to the HC being the cause, and I don't want to hate my MD, so am contacting you. 4 months after beginning HC treatment-- I got an Xray of my lower lumbar: left sided pedicle stress fractures of 3 of the vertebrae. I wonder in retrospect if that was a sign that I was not a candidate? I had prior cervical DGD years before going on HC. As I tirate down off of HC completely-- (now down to 7mg) I am very inflamed and tired. I am also titrating down on Armour thyroid and have gone from 90 mg to 60 with hair loss normalizing. I never even noticed any benefit from being on the HC in the first place! Thank you!

Answer

We often see osteoporosis in people who need the HC, finding this to be present before they begin the HC. The statements by your physicians that the 10 mg of HC is the cause of your osteoporosis is simply not based on science, but on misconceptions relating to higher doses that they use. Attached is a review looking at the safety of low dosing, which they consider 5 mg of prednisone daily, which is equivalent to 25 mg of HC, or 2 1/2 X the dose you have been on. They note:"Data from the four extensively reviewed trials on low dose GC in RA showed that BMD loss over 2 years of low dose prednisone is not significantly different from that with placebo So you don't need to hate your doctor;-) Also, see an article on how to improve bone density. (I have lowered the calcium recommendation to 400-600 mg a day, taken with magnesium and Vit D at the same time).

L&B,
Dr. T