Corticosteroid-induced osteoporosis
Supplements studied for corticosteroid-induced osteoporosis.
Overview
Long-term corticosteroid use commonly causes bone loss, and Calcium plus Vitamin D are the best-supported supplements here. Calcium combined with vitamin D slows steroid-related bone loss across multiple trials, including formulations with 500 mg calcium per dose studied over extended periods.
Vitamin D alone—in forms including cholecalciferol, calcifediol, calcitriol, and alfacalcidol—also reduces bone loss, with more active vitamin D metabolites showing stronger protective signals in some studies. See the heatmap and evidence reviews below for formulation and dose detail.
Effect graph
Relevant supplements
Relevant supplements sorted by DEX Score.
Studies
Find individual evidence reviews for supplements sorted by DEX Score.
2 supplements for rated at least stars. All purchase bands. No minimum star filter.
CalciumView supplement →
Consider purchase·★★★★★
How we scored this▸
- When people need to take corticosteroid medicines for a long time, one common side effect is bone loss, which can lead to weaker bones and osteoporosis.
- Taking calcium together with vitamin D helps slow down this bone loss.
- Studies have tested products such as Oscal, which contains 500 mg of calcium and 125 IU of vitamin D, and Oscal 250 + D, which contains 250 mg of calcium and 125 IU of vitamin D, although it is highly likely that other formulations will offer similar benefits.
- Using these supplements along with corticosteroid treatment can help protect bone strength, although some people may also need stronger medicines from their doctor to keep their bones healthy.
Browse 13 studies·1 meta-analysis
Systematic reviewCalcium and vitamin D for corticosteroid-induced osteoporosis2000n=274
A Cochrane review of 5 trials (274 corticosteroid patients) found calcium plus vitamin D increased lumbar and radial BMD at 2 years but did not reduce fractures.
- Effect
- Benefit
- Population
- Corticosteroid-treated patients
- Participants
- 274
Narrative reviewCalcium and vitamin D therapy in corticosteroid-induced bone loss: what is the evidence?1999
A narrative review concluded calcium alone offers only partial protection against corticosteroid-induced bone loss and should be adjunctive to stronger anti-osteoporosis therapy.
- Effect
- Benefit
- Population
- Patients with corticosteroid-induced osteoporosis
RCTThe role of vitamin D in corticosteroid-induced osteoporosis: a meta-analytic approach1999
A meta-analysis found vitamin D plus calcium improved lumbar spine BMD (effect size 0.60) vs no therapy in corticosteroid-treated patients over ≥6 months.
- Effect
- Benefit
- Population
- Corticosteroid-treated patients
Guide[Pharmacological prevention of osteoporosis in patients on corticosteroid medication]1998
A review noted ~25% of long-term corticosteroid users fracture; calcium/vitamin D alone is insufficient and bisphosphonates show clearer preventive benefit in high-risk patients.
- Effect
- Benefit
- Population
- Postmenopausal women
Effect of low-dose prednisone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers1998
In 8 healthy men, 1 week of 10 mg/day prednisone altered bone turnover markers; adding calcium or calcitriol partially mitigated but did not fully prevent changes.
- Duration
- 1 week
- Dose
- 10 mg/day
- Population
- Men
RCTA randomized, placebo-controlled trial of calcium supplementation for decreased bone density in corticosteroid-using patients with inflammatory bowel disease: a pilot study1996
A 1-year pilot RCT in corticosteroid-using IBD patients found 1000 mg calcium plus 250 IU vitamin D did not significantly improve bone density vs placebo.
- Effect
- No Benefit
- Duration
- 1 year
- Dose
- 1000 mg/day
- Population
- Adults
- Ages
- ≥18
RCTCalcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial1996n=96
In 96 RA patients over 2 years, 1000 mg calcium plus 500 IU vitamin D prevented spinal bone loss in prednisone users who gained lumbar BMD vs placebo losses.
- Effect
- Benefit
- Duration
- 2 years
- Dose
- 500 IU/day
- Population
- RA patients
- Participants
- 96
Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines1996
ACR Task Force guidelines recommend calcium and vitamin D as baseline measures for preventing and treating glucocorticoid-induced osteoporosis alongside other therapies.
Controlled trialVitamin D and calcium in the prevention of corticosteroid induced osteoporosis: a 3 year followup1996n=62
A 36-month minimized trial in 62 corticosteroid-treated patients found vitamin D 50,000 IU/week plus 1000 mg/day calcium did not significantly differ from placebo in lumbar BMD change.
- Effect
- No Benefit
- Dose
- 1000 mg/day
- Participants
- 62
Clinical trialDifferential effect of glucocorticoids on calcium absorption and bone mass1993
Short- and long-term glucocorticoid comparisons found betamethasone and high-dose prednisone impaired calcium absorption and lumbar bone mineral content more than deflazacort.
Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women1986n=16
In 30 postmenopausal women on prednisolone, osteoporotic cases had lower calcium absorption and higher urinary calcium and hydroxyproline than those with normal spine films.
- Population
- Postmenopausal women
- Participants
- 16
RCTCalcium supplements in the prevention of steroid-induced osteoporosis1986
In 13 steroid-treated patients, 1 g/day elemental calcium for 2 months suppressed urinary hydroxyproline, suggesting reduced bone resorption without blocking formation markers.
- Effect
- Benefit
- Duration
- 2 months
- Dose
- 1 g/day
- Population
- Corticosteroid-treated patients
Total body calcium in rheumatoid arthritis: effects of disease activity and corticosteroid treatment1982n=63
Neutron activation analysis in 94 RA patients showed greater total body calcium loss with added low-dose corticosteroids than with NSAIDs alone, beyond disease-related loss.
- Population
- RA patients
- Participants
- 63
Vitamin DView supplement →
Consider purchase·★★★★★
How we scored this▸
- Taking vitamin D by mouth helps prevent bone loss and osteoporosis caused by corticosteroid medicines.
- Forms of vitamin D such as calcifediol, cholecalciferol, calcitriol, and alfacalcidol have all been shown to reduce bone loss.
- The more active types—calcitriol and alfacalcidol—seem to protect bones better than regular vitamin D (cholecalciferol), but they don’t work as well as bisphosphonates.
- Using active or standard vitamin D, either by itself or together with calcium, can help improve bone mineral density in people who develop osteoporosis from corticosteroid use.
Browse 4 studies·3 meta-analyses
MetaEfficacy of alphacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis: a meta-analysis of their effects on bone mineral density and fracture rate2004
A meta-analysis of 17 RCTs found calcitriol/alfacalcidol increased lumbar spine BMD (ES 0.43) and reduced vertebral and nonvertebral fracture rates versus control.
- Effect
- Benefit
- Population
- Osteoporosis patients
MetaPrevention and treatment of glucocorticoid-induced osteoporosis with active vitamin D3 analogues: a review with meta-analysis of randomized controlled trials including organ transplantation studies2004
A meta-analysis found active vitamin D analogues preserved bone during glucocorticoid therapy (ES 0.35) and reduced vertebral fractures (RR 0.56) but were less effective than bisphosphonates.
- Effect
- Benefit
MetaThe comparative efficacy of drug therapies used for the management of corticosteroid-induced osteoporosis: a meta-regression2002n=5
A meta-regression of 45 corticosteroid osteoporosis trials found bisphosphonates most effective for lumbar spine BMD; vitamin D plus bisphosphonate showed greatest benefit.
- Effect
- Benefit
- Population
- Adults
- Participants
- 5
RCTThe role of vitamin D in corticosteroid-induced osteoporosis: a meta-analytic approach1999
A meta-analysis found vitamin D plus calcium improved lumbar spine BMD (effect size 0.60) vs no therapy in corticosteroid-treated patients over ≥6 months.
- Effect
- Benefit
- Population
- Corticosteroid-treated patients
Evidence visualised
Same ratings as above, aggregated so you can see coverage and imbalance.