Long-term use of cortisone increases risk of bone fractures
DEAR DR. ROACH: Is it true that a person over 55 years of age can have bone density problems? Does drinking milk and taking calcium with vitamin D help with this condition? Also, some people take oral cortisone for arthritis. Doesn't this make the bones more susceptible to bone breakage? Some doctors don't feel men can have bone density problems. -- B.W.
ANSWER: Low bone density, also called osteopenia, is a precursor to osteoporosis, which puts people at increased risk for bone fractures.
Over 8 million men in the U.S. have low bone mass or osteoporosis, so any doctor who told you it can't happen in men was either mistaken, or there was missed communication. The overwhelming majority of men with osteoporosis are over 55 -- usually far older than 55, as age is the biggest risk factor for osteoporosis in men. Use of corticosteroids like cortisone or prednisone is an additional risk factor. The longer they are used, and the higher the dosage, the greater the risk. Men and women who need to be on these drugs for one of the many conditions that require long-term steroid use should consider treatment to prevent development of osteoporosis in the first place.
Other risk factors include smoking and excess alcohol use. For men in particular, low testosterone levels are so commonly associated with osteoporosis that I check testosterone levels in all men with the condition. It is especially important in younger men (55 is definitely young, in this context).
Dietary calcium and supplemental vitamin D have been proven to reduce fracture risk in both men and women, but there are many dietary calcium sources beyond milk. Advanced cases of osteoporosis require more potent pharmacologic therapy in addition to vitamin D and calcium, such as a bisphosphonate drug. While these drugs have side effects, the risk of vertebral or hip fracture is much greater than the side effect risk in appropriately chosen patients, both men and women.
DEAR DR. ROACH: The idea that the COVID mRNA vaccines alter one's DNA persists. What are the facts on this? -- J.Q.
ANSWER: There is no evidence of a person's DNA being changed by the vaccine.
If it were so easy to change DNA, many genetic diseases would have been cured long ago. Unfortunately, it's very hard to get our own cells to change their DNA, even when we try to insert the DNA into the cells with technology specifically designed to do so.
By contrast, mRNA is rapidly broken down by the cell's processes. The mRNA from the vaccine is transcribed into protein (the spike protein), which will then be recognized as a foreign invader by the body's immune system, priming the immune system so it can rapidly respond should you ever get exposed to COVID-19. The vaccine mRNA is destroyed by enzymes in the cell, similar to how all the mRNA strands the cell makes on a daily basis are broken down and recycled. mRNA cannot enter the nucleus, so mRNA cannot interact with DNA. There is no mechanism by which mRNA can change DNA.
If you are worried about DNA damage, which is wise, you should do everything you can to avoid COVID. Recent research shows that viruses like COVID-19 cause DNA damage, which could potentially lead to the development of chronic diseases, such as cancer, diabetes and atherosclerosis, and neurodegenerative disorders, like Alzheimer's disease.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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