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Frequently Asked Questions 

Question:

Are there any dietary changes I should make to mitigate side effects from IV Steroids?

 

Answer:

If you are on steroids for your AE, talk to you doctor about supplemental calcium, vitamin D and hormone replacement. Additionally, eat a diet rich in calcium and vitamin D.

Patients who will remain on glucocorticoids for more than a few weeks are clearly at risk for osteoporosis. Steroid‐induced bone loss should be prevented, and if present, should be treated. Exercise programs and the maintenance of a good nutritional status with an adequate calcium and phosphate intake and a restricted sodium intake are recommended. Supplementation with calcium and vitamin D should be given to all patients to restore normal calcium balance. Hormone replacement therapy should be considered in amenorrhoeic women. Patients with medium‐ to high‐dose steroid therapy should receive bisphosphonates or an activated form of vitamin D. Therapies should be continued as long as the patients are on steroids. To ensure that prevention of steroid‐induced osteoporosis is developing as the standard of care for patients receiving long‐term steroid treatment, a broad educational effort directed to physicians of various specialties is needed.

 

Dose recommendations for Calcium, Vitamin D and hormone replacement

 

Recommendations for the prevention and treatment of glucocorticoid‐induced osteoporosis.

Prevention and treatment in all patients
 Supplementation of calcium
 andVitamin D (800 IU/day)
 orActivated vitamin D (e.g. alfacalcidol 1 µg/day or calcitriol 0.5 µg/day)
Patients receiving medium to high dose glucocorticoid therapy
 Supplementation of calcium
 andActivated vitamin D (e.g. alfacalcidol 1 µg/day or calcitriol 0.5 µg/day)
Treatment in all men and postmenopausal women
 Bisphosphonates (e.g. etidronate)
Patients who are hypogonadal
 Hormone replacement therapy (e.g. oestrogen or testosterone)

 

 

Reference: https://academic.oup.com/ndt/article/18/5/861/1833137

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