Some older individuals will experience side effects that are more pronounced. Older adults have an increased risk of developing high blood pressure or osteoporosis (a disorder in which the bones lose mass and density) when taking corticosteroid drugs. Women, in particular, are at risk for this condition. However, recent research has suggested that the risk of non vertebral fracture in older adults is not higher in the short term when inhaled corticosteroid treatments are used.
Depending on the patient’s individual situation, older adults may be advised to undergo bone density screening, a test that can help detect osteoporosis. Patients at risk may also benefit from taking calcium supplements, undergoing hormone replacement therapy and exercising regularly.
Patients over the age of 50 also risk the development of cataracts (clouding of the lens of the eye) and glaucoma (a group of diseases that can damage the optic nerve, resulting in vision loss). For this reason, older adults taking high doses of corticosteroids may be advised to undergo eye examinations.
Because of these side effects, doctors frequently choose safer medications, such as the 5-ASA drugs and antibiotics, as initial therapy. But there are a number of ways to reduce the risk of developing side effects. These include rapid but careful tapering off of steroids; alternate-day dosing; rectally applied corticosteroids; and rapidly metabolized corticosteroids such as budesonide (described above). To help prevent osteoporosis, many doctors routinely prescribe calcium supplements as well as multivitamins that contain vitamin D. Another option is the use of bisphosphonates, such as risedronate (Actonel®) and alendronate (Fosamax®). These compounds, which have been shown to help avert bone loss, are effective in treating and preventing steroid-induced osteoporosis.