How to protect teeth and spine when using prednisone long term?

Bones, joints and muscles
1

Good afternoon to all smile I am doing my homework on how to use prednisone

long term.I read yesterday on another forum that it can cause your jaw or

teeth to deteriorate sad that's scary!! But I have come to know many on this

forum whose advice and experience is priceless.

What can be taken to protect the bones and what side effects will that

medication possibly cause? I also have atrophic chronic gastritis for

which I take rantidine for twice a day.Is that enough protection?

I remember Eileen and Anhaga mention something about breakfast

lunch and dinner that had to do with vitamin d and prednisone but

can't recall what that was about.

I see my rheumy April 4th and want all the info I can get in case he

tries to dissuade me from using steroids.My husband takes already

methotrexate and I want nothing to do with it.I know it works for

him and so many others,but with my fibro I am hypersensitive to meds.

Thank you to all who chime in with support..Many hugs

2

tory38006,

          I took prednisone for three years and the side effects that I had were sleeping difficulties. Recently I am back on prednisone and in addition to sleeping problems I have experienced heartburn. It appears that the side effects are quite different for each individual.

3

I assume you are taking pred for PMR?  If so, there is no other medication which will work so a rheumatologist should not make you stop taking it, although you will be encouraged to slowly reduce your dose to the lowest level which controls your symptoms until such time as the disease goes into remission.

Prednisone may cause some bone thinning and in fact can be a major cause of osteoporosis although many people have few if any effects.  It's wise to take precautions.  However it's the osteoporosis drugs which ironically have the most deleterious effects on the jaw and teeth.  Take calcium, Vitamin D3, Vitamin K2 (not K1 which you easily get from leafy greens), magnesium to balance the extra calcium you are taking.  Do not accept any osteoporosis drugs without having a DXA first.  Most people do NOT need these drugs, especially if they follow a good diet, take a few supplements and do lots of appropriate exercise (weightbearing, like walking, Nordic walking, tai chi, other activities you enjoy; although swimming is generally not helpful for bones strengthening muscles is good for bones so swimming does have a small beneficial effect).

You do not take calcium supplement at same time as pred because pred will prevent the calcium from being properly absorbed.  Also, take calcium in relatively small doses - 400 IU twice a day, rather than 800 in one go, for example, as the body can only absorb just so much at one time.  Lots of us have pred at breakfast, and calcium at later meals.  I have pred and iron at breakfast, iron at lunch, calcium at supper and near bedtime.  You can take calcium at lunch but I've found the evening calcium really helps me sleep well.  

Can't speak to mtx, but I expect that you will get some advice about that from others.  However it isn't usually suggested except in cases where a patient is having a very hard time reducing pred.  

All the best.

 

4

If you have PMR then pred is the only option for management - your doctor may want you to also take methotrexate but there is no proof it makes any long term difference at all to the side-effects of pred even though it MAY allow you to take slightly less pred.

Ranitidine is nothing to do with protection for anything other than your stomach lining. Some doctors would try to switch you to a PPI (omeprazole for example) but they have more side effects than ranitidine and can themselves lead to osteoporosis by preventing calcium absorption. Ranitidine probably does too but to a lesser extent.

When you start pred then you need a dexascan done immediately to assess the state of your bones BEFORE pred. You also need to take calcium and vit D supplements right from the start - the likelihood of side effects from them is small although some people complain about wind and bloating from calcium - try a different sort if it does. Anhaga has written well about how to use it - 2 times a day with lunch and tea/dinner avoids a clash with the pred and allows optimum absorption of calcium. Some fat is always helpful for transport from the gut into the blood. You also need the vit D level in your blood checked - and put right if it is low. 

On the basis of that scan you will then be advised what "they" want you to take. The basic is the calcium and vit D - but many doctors will want you to take bisphosphonates as well. These "bone protection" drugs are claimed to increase bone density and reduce fracture risk - they certainly increase bone density and possibly reduce fracture risk for a time but it is now being suspected that after a couple of years they result in the formation of rather brittle bone and that is what leads to to the fractures and jaw problems that are complained of. Dentists are very reluctant to work on patients who have taken bisphosphonates. Long term use has been common - but is advised against. 

I have been on pred at above 10mg for much of the last 8 years. My bone density has barely changed in that time and I have not taken bisphosphonates and would not do so as long as my bone density stays as it is. I had a rheumy trying to persuade me last week. I have taken calcium and vit D religiously the entire time. 

Your existing history of gastritis may be a contraindication to taking bisphosphonates - alendonic acid/Fosamax is the usual starter. There are other drugs - and as Anhaga can explain you can build bone density by diet, exercise and simple supplements.

But the only way you can find out what side effects YOU will have is by taking pred! Everyone is different. I have next to none. I gained weight with ine form, I lost it when I was switched to another and cut my carb intake drastically. Low carb is definitely the way to go when on pred - it really does help avoid the weight gain and fat deposits that are so common with pred.

5

Daniel thanks for replying.I just recently had a short run on

taking 6 days worth of prednisone and that was what I dealt

with.I slept kind of and then would be up at 3am

6

I was given a 6 day pack to see if it would help the symptoms

I've had of pmr for quite some time now.I have fibromyalgia

and head to toe osteoarthritis so it's been taking awhile to

work through sorting things out.I have the typical pmr

symptoms but lack some of the stiffness everyone seems to

describe.I can raise my arms above my head but almost can't

fold laundry or change a pillow case.That movement causes

pain and deep ache.I also have the deep deep ache in both

thighs,especially in the back of them.

I also have a but of temporal headache pain left side that

seems to hit once a month but the tenderness is there if

I put a light touch to it.In the last year I have chatted with

you,Eileen and others who have helped me sort through

my symptoms by answering my questions.You all have

been a part of an extended health team and I thank you

so much I am pretty sure I have pmr and hopefully on

April 4th I will get my rheumy to agree since the symptoms

are consistent even though they wax and wane.I will keep

you all updated with what happens

7

When I was on the pred I had very little symptoms.Probably

about 75% gone.I felt some twinge of ache but it was like

I could function much better.I will take everything you and

Anhaga have suggested and will print up and keep a folder

of notes so I can discuss on my appt here shortly.

I'm in total agreement with you on the bisphosphonates.

My mom had taken an infusion of something about a year

or so before she passed and she was voicing her concerns

about regretting her decision.She had a severe case of

scoliosis and was trying to protect her spine and hips.

Someone had also shown her some info on the negative

effects.

I took your advice on diet a few weeks ago and am eating

salads a plenty But how many forms of pred are there?

I do recall taking some several years ago and I turned in to

a crankmeister.But this last time I was fine.I do take vit d3

5,000 unit caps daily since I have low levels.I will have to

research the calcium and what kind.I will ask for the scan

I am 52 and it would be nice to know my baseline if I am

diagnosed

8

It depends where you live - in the UK they use prednisolone, in the USA they use prednisone and methylprednisolone. These are the medium acting corticosteroids so their effects lasts about 24 hours and you take one dose a day. 

9

Did the pred help your PMR symptoms?

10

I'm in the U.S and it was the methylprednisolone that I had.

I have already talked with him on my last appt about mtx and

not taking it.I don't get it why steroids are so hard to be given

but I am guessing people can become addicted to them for

whatever reason

11

Yes they did.I didn't have no where near as much aches or pains.

I paid close attention to how I felt the first 24 hrs and I didn't have

the aches in my deltoid muscles accept maybe a slight twinge.

I for sure had energy and it was nice to feel better

12

I never heard that the glucocorticoids were in themselves addictive.  Quick check of dr google shows that glucocorticoid receptors have a part to play in addiction to other substances so perhaps some doctors are confused by that?  The main concern is there are some adverse effects from pred and obviously the shorter the amount of time we are on them, and the lower the dose we can comfortably manage with, the better.  But there's no point giving us this medication, which helps us, and then insisting we stop taking it before we are ready to.

We do have to do our part, however, to improve our health as much as we can.  I believe that helps us lower the stress, physical and psychological, in our bodies and can help us reduce our dose to a level reasonably safe for the long term.

13

You do not become addicted - not like with the opiod painkillers they will hand out like sweeties. They do suppress the activity of the adrenal glands - and that means your body is dependent on being given enough pred as a replacement therapy - but if you wean off them slowly enough the function will come back for the majority of patients.

When steroids were first invented in the late 1940s they gave them to "arthritis" patients who were in wheelchairs - many got up and walked. It was a miracle and they used them for eveyone they worked for. But they used very high doses, they knew no better at the time, and these led to a lot of severe and serious side effects. The stories have become legend and were told to doctors, warning them not to use pred unnecessarily. They still fairly happily use it for short term courses - but they are terrified of using it for any longer. It's worse in the USA than in the UK, where it seems to be worse than in the rest of Europe. In the US I suspect it may have something to do with liability - most patients don't understand the risks and would blame the doctor who gave it to them.

Whatever - there are a few illnesses where pred is the only answer for management of the symptoms. I suspect many doctors don't want to admit they can't cure you and they know how much many people fear steroids so they do play on that a bit.

But if a moderate dose of pred gives you your life back until the PMR goes into remission, which it does for 75% of patients in up to 4 to 6 years, then I have no problem with most of the potential side effects.The biggest problem is that doctors hear a figure of 2 years - which applies to about 25% of patients - and then nag the rest of us to get off pred and introduce all sorts of other stuff to make us feel they are doing something. Instead of indulging in the most difficult thing for any doctor to do: Masterly inactivity! Sometimes it is the right thing to do!!

14

Oh ok,that makes sense.I might have gotten them confused with the

steroids athletes take.I wish Dr's had an everyday knowledge of what

it feels like to go through these symptoms then they could understand

that no one likes to deal with the side effects but that the steroids help

just to live day to day.

I agree on doing our part. Medications can only do so much.I need to

remember that as I zip past the bakery isle ha ha

15

it must have been horrible to live in that time.Those who suffered pain

and distress like that . I totally get it when you are nagged to switch

to different treatments.If something is working then don't mess with it!!

16

i don't know what I said lol to be moderated.Thanks for looking that up

and explaining.I will try to convince my rheumy that I am willing to do my

part and do take care of myself.He is a fair Dr,I just need to sound

convincing in my symptoms that they are not fibro related and that the

steroids worked which shows it wasn't fibro related.I have had all my blood work done and so he has all that information to work with

17

A typo where there is a full stop without a space after it can trigger the computer to automatically block a post. Or a set of letters in the middle of a word that spells something naughty   And of course - no links except to another post on the site... 

But I know the feeling all too well!

18

for sure it was nice!! And there was no links.It must have been

a typo.But if it pops up eventually can you please show me where

it was.

And I'm happy to know I'm not alone!!

19

The site has been playing eejits the last few days - it could well have been nothing!!!!!

20

Ha ha ha I have never heard that one before and I have no clue

but I get the picture and I thought something was up.