Do Steroids Raise Calcium Levels?
No, steroids typically do not raise calcium levels. In fact, corticosteroids are often used to treat hypercalcemia in certain conditions, as they decrease calcium levels by reducing calcium absorption from the gut and increasing urinary calcium losses.
Mechanism of Steroids on Calcium Metabolism
- Corticosteroids reduce calcium absorption from the gastrointestinal tract and increase urinary calcium losses, which can lead to secondary hyperparathyroidism and bone resorption 1
- These effects contribute to corticosteroid-induced bone disease, which affects approximately 35-40% of patients with inflammatory bowel disease who use steroids 1
- Long-term steroid use is a significant risk factor for osteopenia and osteoporosis due to these calcium-lowering effects 1
Clinical Evidence for Calcium-Lowering Effects
- Corticosteroids are actually used as a treatment for hypercalcemia in several conditions:
- In sarcoidosis-related hypercalcemia, corticosteroids rapidly reduce circulating 1,25-dihydroxy vitamin D3 levels, which precedes the fall in serum calcium 2
- Prednisone produces prompt and lasting reduction of serum calcium to normal levels in cases of vitamin A-induced hypercalcemia 3
- In granulomatous disorders like sarcoidosis, tuberculosis, and fungal infections, corticosteroids cause prompt reversal of hypercalcemia 4
Steroid Effects on Bone Health
- The British Society of Gastroenterology recommends that all patients receiving corticosteroids should receive calcium and vitamin D supplementation to counteract the calcium-lowering effects 1
- Specifically, patients should receive 800-1000 mg/day calcium and 800 IU/day vitamin D while on corticosteroids 1
- A Cochrane review confirmed that calcium and vitamin D supplementation prevents bone loss from the lumbar spine and forearm in patients treated with steroids 1
- Patients starting corticosteroids should be assessed for osteoporosis risk, with high-risk patients started on bisphosphonate therapy 1
Hypercalcemia Management in Clinical Practice
- In multiple myeloma, excess bone resorption from myeloma bone disease can lead to hypercalcemia, which should be treated with hydration, bisphosphonates, steroids, and/or calcitonin 1
- For treatment of hypercalcemia in multiple myeloma, zoledronic acid is preferred among bisphosphonates 1
- In cases where steroids are contraindicated or ineffective for treating hypercalcemia, alternative agents like chloroquine, hydroxychloroquine, and ketoconazole may be considered 4, 5
Monitoring and Management Recommendations
- Patients on long-term steroids should have their bone mineral density assessed by bone densitometry, particularly if they have a high FRAX score or are under 40 with risk factors 1
- Lifestyle modifications are important for patients on steroids, including smoking cessation, reducing excess alcohol intake, and regular muscle-building and weight-bearing exercise 1
- Steroid-induced hyperglycemia is a common side effect that requires monitoring, but this is distinct from effects on calcium metabolism 1, 6
In conclusion, rather than raising calcium levels, corticosteroids typically lower serum calcium through reduced intestinal absorption and increased urinary excretion. This calcium-lowering effect contributes to the well-documented risk of osteoporosis with long-term steroid use and is the reason why calcium and vitamin D supplementation is recommended for patients on corticosteroid therapy.