Should a patient tapering prednisone (corticosteroid) be on vitamin D and calcium supplements?

Calcium and Vitamin D Supplementation During Prednisone Tapering

Yes, patients tapering prednisone from 50mg should receive calcium and vitamin D supplementation throughout the tapering period and for at least 3 months after completing the taper. 1

Rationale for Supplementation

Glucocorticoids like prednisone negatively impact bone health through multiple mechanisms:

• Decreased intestinal calcium absorption
• Increased urinary calcium excretion
• Inhibition of bone formation
• Uncoupling of bone formation and resorption

The risk of bone loss begins early in treatment and is most pronounced within the first 3-6 months of therapy, even at lower doses.

Recommended Supplementation

For patients on prednisone >7.5 mg daily for more than 3 months:

• Calcium: 800-1000 mg daily 1
• Vitamin D: 800 IU daily 1

Implementation Algorithm

1. Start supplementation immediately - Don't wait until the taper reaches a certain point

   • The patient is starting at 50mg, well above the 7.5mg threshold that triggers the recommendation
   • Bone loss begins rapidly after starting glucocorticoids

2. Continue throughout the entire taper

   • The patient will be on >7.5mg for approximately 8 weeks during the taper
   • Even at lower doses (below 7.5mg), some bone effects persist

3. Maintain supplementation for at least 3 months after completing the taper

   • Bone remodeling effects continue after discontinuation of prednisone

4. Consider additional risk assessment

   • If the patient has additional risk factors for osteoporosis, consider bone mineral density testing
   • For prolonged courses (>3 months), bisphosphonate therapy may be indicated based on risk factors 1

Important Considerations

• Timing of supplementation: If the patient is also on antibiotics, calcium supplements should be taken at least 2 hours before or 6 hours after antibiotics to prevent decreased absorption 2

• Monitoring: For patients on long-term prednisone (>3 months), monitor for:

  • Body weight
  • Blood pressure
  • Serum lipids
  • Blood/urine glucose
  • Signs of bone loss 1

• Research support: A randomized controlled trial demonstrated that calcium and vitamin D supplementation prevented bone mineral density loss in the lumbar spine and trochanter in patients on low-dose corticosteroids (average 5.6 mg/day) 3

Common Pitfalls to Avoid

1. Waiting too long to start supplementation - Bone loss begins early in treatment
2. Stopping supplementation too soon - Effects on bone continue after discontinuation
3. Inadequate dosing - 800-1000 mg calcium and 800 IU vitamin D are the minimum recommended doses
4. Not considering bisphosphonate therapy for high-risk patients on prolonged courses
5. Taking calcium supplements simultaneously with antibiotics if prescribed together

Even with this relatively short taper (approximately 14 weeks total), the initial high dose and gradual reduction warrant calcium and vitamin D supplementation to protect bone health.