Steroids and Vitamin D

October 27th, 2010 by DoctorZaidi


Steroids (even inhaled steroids) antagonize the effects of vitamin D. For example, in bone, vitamin D enhances bone formation by stimulating osteoblasts, increasing calcium absorption from the intestines and preventing secondary hyperparathyroidism. Steroids do exactly the opposite: they have an inhibitory effect on osteoblasts, decrease calcium absorption from the intestines, increase calcium wasting from the kidneys and cause secondary hyperparathyroidism. In this way, steroids cause rapid bone loss (osteoporosis).

In addition to bone, some of the other opposing effects of vitamin D and steroids are as follows:

Vitamin D boosts up the immune system whereas steroids suppress the immune system.

 Vitamin D reduces blood pressure whereas steroids  increase blood pressure.

Vitamin D reduces insulin resistance whereas steroids increase insulin resistance.

Vitamin D builds up muscles whereas steroids cause myopathy.  

It is pretty obvious that steroids antagonize the effects of vitamin D. What is the mechanism?

One known mechanism is that steroids alter the vitamin D receptor. That’s why there are such widespread clinical findings of HDD (Hormone D Deficiency) in people taking steroids.

Steroids also cause an increase in obesity and consequently, decrease the available circulating vitamin D.

Could there be other mechanisms? Probably yes and we will learn about them as more and more researchers devote their efforts to this non-profit, non glamorous field of medicine.

However,  from a clinical standpoint, the message is very clear. Steroids rob you off the beneficial effects of Hormone D. It has been shown that in a  brief  duration of 5 days, steroid use causes an elevation in parathyroid hormone level  and an increase in renal calcium wasting.

Therefore, I recommend my patients double or even triple their dose of vitamin D while they take steroids, while paying close attention to serum and urine calcium. Because today, no drug can effectively treat steroid-induced osteoporosis. “Prevention is better than a cure” is your best bet when it comes to steroid-induced osteoporosis.

Written by Sarfraz Zaidi, MD.

All Rights Reserved.

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