Have had PMR for 2 years now. Started at 15 mg of prednisone and symptoms were dramatically improved w/n 24 hours. Have been struggling with trying to reduce using the DSNS method and with multiple ups and downs and switching to methylprednisolone have now settled at 12.5mg. Several weeks ago I started to have severe lower back pain. Went for an MRI and a had a consult with a pain management specialist and was told I have a stress fracture of my L5 vertebrae. No history of trauma so it's a fairly good chance it's from osteoporosis related to the methylprednisolone. I am guessing my rheumy will want to put me on a bisphosphonate which I do not want to take ( on too many other meds for other issues ). Ideally I would love to reduce or stop the methylprednisolone but as you know it's a Catch 22 situation. **I would appreciate your thoughts on what I should do since I feel trapped and would also love to hear from others regarding your experience, both positive and negative, with bisphosphonates.**
Have you had a dexascan to establish what your bone density currently is? That is the first step - and then, you work from there.
i was just diagnosed with bilateral hip osteoporosis after being on pred for 3 YEARS. Since my spine has extensive hardware for scoliosis correction I am starting FORTEO next week . This drug is specific for pred induced osteoporosis and is very different from bisphosphonates. It actually builds normal bone rather than just hardening it. The pharmacist said I can continue with the micronutrient bone protocol which had been very effective in reversing osteoporosis in persons not currently taking steroids.
Google healthunlocked my osteoporosis journey for some ideas about what you can do to help your bones. These things can be done whether or not you need a medication and the only side effect is better over all health! As teriparatide can only be taken for two years this protocol also sets you on the right path for continuing to improve your bone health.
hi scotth…I too found out I’ve got several compression fractures on my spine after having a bone density test.
I had NO idea, but it certainly explains all the back pain I’ve got, especially when standing for more than a minute!
my doc wanted to put me on fosamax but I declined as I’d read of too many side effects and God knows I was Already having more than my fair share of them with prednisone!
she agreed to let it go for awhile so we’ll see what happens. in the meantime, I’m inclined to wrap myself in “bubble wrap” so as to avoid anymore fractures!!
Had this dexa about a year ago :
Study includes AP spine analysis L1 through L4 as well as dual proximal femur.
Lumbar spine bone mineral density is in normal range. Since April 2016 average lumbar
spine bone mineral density, evaluate L1-L4, has increased by 1.0%.
Bone mineral density of the left femoral neck is at the lower range of normal with T score
of -1.0 at the lower range of normal. The right femoral neck is osteopenic with a T score
of -1.2. Since April 2016 ( last scan ) mean femoral neck bone mineral density has increased by 4.9%.
Dual femur FRAX analysis as follows: 10 year probability of major osteoporotic fracture
8.4%, hip 1.3%.
IMPRESSION:
Osteopenia M85.80
Ironically the scan was done from L1 - L4 and my compression fx was L5.
Spinal compression fractures will happen anyway, they require no stress, though stress will make them more likely. If your spinal bone density is that low, you need appropriate medication. Even Anhaga and I agree with that,
You need another dexascan- there is no reason for problems with the figures you had a year ago, they are better than mine! It is possible the pred has accelerated bone density loss. And maybe it is just really bad luck…
I too have been taking pred, for nine months, and my T9 vertebrae has a compression fracture. The rhueumy put me on bisphosphonates, and I was really dreading it. However, I hardly notice that I am taking them now, (once a week), and don’t have any side effects from it, that I can see anyway. I am going to ask him about the Forteo, Tuesday, this week.
Hi Scott, i don’t want to tell you what to do. i was also pescribed bisphosphonates for osteopenia, like you I did not want to take them so i didn’t, I didn’t tell my G.P. my bloods 6 months later showed no more decrease.
i know everyone is different, I am really glad to not have taken them
Thanks so much Anhaga, fabulous amounts of information here I’m so grateful for the pointer. I know we keep saying it but this forum makes such a difference as we progress with this illness, Pred and its side effects.
Margo, bloodwork will not show bone density changes; only a bone densometry xray - and that’s done at yearly or longer intervals. That test should be done on the same machine for an accurate comparison.
I couldn’t find your osteoporosis journey on healthunlocked. Could you be more specific or send me info privately?
I was going to say the same as karenjaninaz. The bone panel has a role in monitoring the effect of medication on bone turnover - it doesn’t replace a dexascan, that’s different.
Here is the link
It was the first link that came up for me - obviously my google is well-trained 
It’s now been 4 weeks of dealing with the pain from my stress fracture of L5 & I feel my PMR pain has increased.
Is the stress of dealing with the fracture pain and the possibility of back surgery enough to trigger increased PMR pain and should I “give in” and increase the prednisone ? I am reluctant because it’s likely the steroid is what contributed to the fracture and I don’t want to increase the chances of it happening again.
Between a rock and a hard place.
Thank you Eileen. I didn’t know you could send the actual link to HealthUnlocked now, that’s good to know.
That’s interesting Eileen. I think the test was to see how the body has absorbed the bisphosphonates
Oh yes, i think the test was to check the absorption of the bisosphonates
Not sure if everyone can - I have pre-approval. But if anyone mentions something that I can add I do.