- With Mayo Clinic rheumatologist
April Chang-Miller, M.D.read biographyclose window
April Chang-Miller, M.D.April Chang-Miller, M.D.
Dr. April Chang-Miller is board certified in internal medicine and rheumatology and is a consultant in the Division of Rheumatology at Mayo Clinic in Arizona.
Dr. Chang-Miller's primary field is rheumatology with special interests in inflammatory joint diseases called seronegative spondyloarthropathies, such as ankylosing spondylitis and psoriatic arthritis. She also cares for patients with rheumatoid arthritis and polymyalgia rheumatica.
The New York City native is a graduate of the Yale School of Medicine. Dr. Chang-Miller joined the Mayo Clinic staff in Rochester, Minn., in 1991, and in 2002 she relocated to Mayo Clinic in Arizona. She is a fellow in the American College of Rheumatology and has been on the board of directors of the Arthritis Foundation North Central Chapter.
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Treatments and drugs (4)
- Botox injections: Can they relieve arthritis pain?
- Hip resurfacing: An alternative to conventional hip replacement?
- Arthritis pain medications: Do they raise blood pressure?
- see all in Treatments and drugs
Lifestyle and home remedies (4)
- Rheumatoid arthritis diet: Do certain foods reduce symptoms?
- MSM for arthritis pain: Is it safe?
- Isometric exercises: Good for strength training?
- see all in Lifestyle and home remedies
Alternative medicine (3)
- Mangosteen juice: Can it relieve arthritis pain?
- Yucca: Can it relieve arthritis pain?
- Do infrared saunas have any health benefits?
Osteoporosis and long-term prednisone: What is the risk?
I've been taking prednisone for my rheumatoid arthritis, but I've heard that it can increase my chances of developing osteoporosis. How big is the risk?
from April Chang-Miller, M.D.
Prednisone and similar drugs all cause bone loss. It's difficult, however, to separate prednisone use from the other things that might increase your risk of osteoporosis — your age, your sex and some aspects of your lifestyle, for example. Rheumatoid arthritis itself can lead to bone loss.
Prednisone is a corticosteroid (kor-tih-ko-STARE-oid) medication, highly effective for treating inflammation in rheumatoid arthritis and many other conditions. Unfortunately, corticosteroids also interfere with bone maintenance and limit the amount of calcium absorbed by your intestines. This can dramatically weaken bones and lead to osteoporosis.
In general, the higher the dose of prednisone you take and the longer you take it, the greater the risk. To counter the risk, do weightbearing exercise, avoid alcohol and do not smoke. Taking calcium and vitamin D supplements also can help reduce the amount of bone loss caused by steroids such as prednisone.
If you'll be taking prednisone for more than a few months and you have other risk factors for bone loss, your doctor may prescribe medications specifically designed to treat osteoporosis.Next question
Rheumatoid arthritis diet: Do certain foods reduce symptoms?
- Grossman JM, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care & Research. 2010;62:1515. http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2151-4658. Accessed March 21, 2011.
- Rosen HN. Pathogenesis and clinical features of glucocorticoid-induced osteoporosis. http://uptodate.com/home/index.html. Accessed March 22, 2011.
- den Uyl D, et al. Advances in glucocorticoid-induced osteoporosis. Current Rheumatology Reports. In press. http://www.springerlink.com/content/h7526480765p4648. Accessed March 22, 2011.