From the Guidelines
For patients on prednisone for Polymyalgia Rheumatica (PMR), the recommended calcium supplementation is 800-1000 mg of elemental calcium daily, combined with vitamin D supplementation of 800 IU daily, as suggested by the British Society of Gastroenterology consensus guidelines 1. This recommendation is essential for all patients starting corticosteroids, which is common in PMR treatment where prednisone is typically used. Calcium supplementation helps counteract the bone-depleting effects of prednisone, which increases bone resorption and decreases bone formation, leading to osteoporosis. The calcium should be divided into two daily doses for better absorption, preferably taken with food. Some studies suggest that calcium citrate may be better absorbed than calcium carbonate, especially for older adults or those on acid-reducing medications 1. Patients should also be advised to incorporate calcium-rich foods in their diet and maintain weight-bearing exercise as tolerated. Regular bone density monitoring is important while on prednisone therapy, and some patients may require additional prescription medications for bone protection depending on their risk factors and duration of steroid treatment. Key considerations include:
- Assessing and modifying risk factors wherever possible, such as prolonged or high-dose steroids, uncontrolled inflammation, weight loss, and malabsorption, lack of physical activity, alcohol excess, and smoking 1.
- Using tools like FRAX to estimate fracture risk, taking into account the average dose of prednisolone or equivalent, and adjusting the risk accordingly 1.
- Considering prolonged bisphosphonate treatment, switch, and/or referral to a specialist clinic as appropriate, and ensuring calcium and vitamin D intake 1.
From the Research
Recommended Calcium Dose for Patients on Prednisone for PMR
The recommended calcium dose for patients on prednisone for Polymyalgia Rheumatica (PMR) is not explicitly stated in the provided studies. However, the following information can be gathered:
- According to 2, calcium carbonate (1000 mg/d) and vitamin D3 (500 IU/d) supplementation prevented bone loss in the lumbar spine and trochanter in patients with rheumatoid arthritis who were treated with low-dose corticosteroids.
- The study 2 suggests that calcium and vitamin D3 supplementation can help prevent bone loss in patients taking prednisone, but it does not provide a specific recommended dose for PMR patients.
- Other studies, such as 3 and 4, discuss the effects of prednisone on bone density and the potential benefits of prophylaxis, but they do not provide specific recommendations for calcium dosage.
- The study 5 recommends osteoporosis prophylaxis for PMR patients, but it does not specify the exact calcium dose.
Key Points to Consider
- Patients on prednisone for PMR may be at risk of bone loss and osteoporosis.
- Calcium and vitamin D3 supplementation may help prevent bone loss in these patients.
- The optimal calcium dose for PMR patients on prednisone is not clearly established in the provided studies.
- Further research or consultation with a healthcare professional may be necessary to determine the best course of treatment for individual patients.