From the Guidelines
Chronic prednisone use in geriatric females requires careful management due to increased risk of adverse effects, and the lowest effective dose should be used, typically starting at 5-10 mg daily and tapering to the minimum dose that controls symptoms, as recommended by the most recent guidelines 1.
Key Considerations
- Treatment duration should be limited when possible, with a goal of discontinuation if the condition allows, to minimize the risk of long-term side effects such as osteoporosis, diabetes, and cardiovascular disease 1.
- Geriatric females are particularly susceptible to osteoporosis with chronic prednisone use, so calcium (1200-1500 mg daily) and vitamin D (800-1000 IU daily) supplementation is essential, along with consideration of bisphosphonates like alendronate 70 mg weekly, as suggested by previous studies 1.
- Blood glucose monitoring is necessary as prednisone can worsen or precipitate diabetes, and blood pressure should be checked regularly as hypertension may develop or worsen, highlighting the importance of regular monitoring and management of these comorbidities 1.
- Other common side effects include increased infection risk, muscle weakness, skin thinning, cataracts, and mood changes, which should be carefully monitored and managed to minimize their impact on the patient's quality of life 1.
Management Strategies
- Gastroprotection with a proton pump inhibitor like omeprazole 20 mg daily should be considered, especially if there's concurrent NSAID use, to reduce the risk of gastrointestinal complications 1.
- Medication should be taken in the morning to minimize sleep disturbances and adrenal suppression, and abrupt discontinuation must be avoided due to risk of adrenal crisis; instead, gradual tapering by 2.5 mg every 1-2 weeks is recommended, as advised by previous guidelines 1.
- The benefits of prednisone therapy must clearly outweigh these significant risks, particularly in this vulnerable population, and regular review and assessment of the patient's condition is necessary to ensure that the treatment remains effective and safe 1.
From the FDA Drug Label
Clinical studies did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy In particular, the increased risk of diabetes mellitus, fluid retention and hypertension in elderly patients treated with corticosteroids should be considered.
The use of chronic prednisone in geriatric females requires cautious dose selection, typically starting at the low end of the dosing range. Key considerations include:
- Decreased hepatic, renal, or cardiac function
- Concomitant disease or other drug therapy
- Increased risk of:
- Diabetes mellitus
- Fluid retention
- Hypertension Due to the lack of specific studies on geriatric females, it is essential to monitor closely and weigh the potential benefits against the risks 2.
From the Research
Chronic Prednisone Use in Geriatric Females
- Chronic prednisone use in geriatric females can lead to various adverse effects, including osteoporosis, which is a significant concern in this population 3.
- A study published in 2006 found that primary care physicians often fail to evaluate and treat patients for osteoporosis secondary to long-term prednisone use, especially in those without comorbid risk factors 3.
- Another study published in 2022 suggested that low-dose prednisolone can be an effective and safe treatment option for elderly patients with rheumatoid arthritis, with a low risk of adverse events 4.
- However, a 2020 study found that long-term use of oral budesonide, a type of corticosteroid, may be associated with an increased risk of osteoporotic fractures, particularly spinal fractures, in patients with microscopic colitis 5.
- The use of prednisone chronotherapy, which involves taking prednisone at a specific time of day to coincide with the body's natural circadian rhythms, may help reduce the risk of adverse effects and improve efficacy in patients with rheumatoid arthritis 6.
- When prescribing steroids to elderly patients, including geriatric females, it is essential to consider the effects of aging on adrenal function and to weigh the risk-benefit factors carefully, taking into account factors such as muscle mass and plasma volume 7.
Adverse Effects of Chronic Prednisone Use
- Osteoporosis: a significant concern in geriatric females due to the increased risk of fractures and osteoporotic fractures 3, 5.
- Suppression of the hypothalamic-pituitary-adrenal axis: a potential risk of long-term prednisone use, although modified-release prednisone may have a similar safety profile to conventional prednisone 6.
- Increased risk of infections: a potential adverse effect of chronic prednisone use, particularly in elderly patients with compromised immune systems.
- Mood changes: prednisone can cause mood changes, including anxiety, depression, and insomnia, which can be particularly problematic in geriatric females.
Management of Chronic Prednisone Use in Geriatric Females
- Regular monitoring of bone mineral density to assess the risk of osteoporosis and fractures 3.
- Consideration of alternative treatment options, such as low-dose prednisolone or prednisone chronotherapy, to minimize the risk of adverse effects 4, 6.
- Careful weighing of the risk-benefit factors when prescribing steroids to elderly patients, taking into account factors such as muscle mass and plasma volume 7.
- Regular review of medication regimens to ensure that the benefits of prednisone use outweigh the risks and to minimize the risk of adverse effects.