Corticosteroids (Oral Steroids)
Common brand names: Prednisone, Methylprednisolone, Dexamethasone
Four nutrients listed against this medication. The most severe is marked critical.
At a glance
Two of the four are marked well documented. The other two carry their own evidence levels.
At a glance
- Calcium + Vitamin D3Critical · Well documented
- MagnesiumModerate · Mechanism only, no human trial
- ZincModerate · Well documented
- PotassiumModerate · Moderate evidence
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, Corticosteroids reduce intestinal calcium absorption and increase renal calcium excretion. They also suppress osteoblast activity. Long-term use causes glucocorticoid-induced osteoporosis, the most common drug-induced osteoporosis.
Common signs, Bone density loss, fracture risk, osteoporosis, dental deterioration
Gennari (Br J Rheumatol, 1993; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 8495275): glucocorticoids reduce intestinal calcium absorption, a driver of steroid-induced bone loss.
Calcium 1,000–1,200 mg daily from food first, with vitamin D3 1,500–2,000 IU, is the range in common use for steroid-induced bone loss. Gennari measured calcium absorption and bone mass on glucocorticoids and is not the source of this regimen; no guideline body is cited for it here.
Mechanism, Corticosteroids increase renal magnesium excretion. Magnesium deficiency potentiates the bone loss caused by steroids.
Common signs, Muscle cramps, bone loss, fatigue, insulin resistance
Glucocorticoids can increase urinary magnesium excretion (mechanistic). The paper usually cited here, Rude (Magnes Res, 1999), is a rat study of magnesium-deficiency osteoporosis with no steroid exposure, a different question entirely. No human study measures steroid-caused magnesium depletion.
Magnesium 400 mg daily is a figure in common use, not from a trial cited on this row. The cited paper is a rat model of magnesium-deficiency osteoporosis with no steroid exposure, and no cited trial tested the bisglycinate form.
Mechanism, Corticosteroids increase urinary zinc excretion and impair zinc utilization, relevant for immune function and wound healing.
Common signs, Impaired wound healing, immune suppression, increased infection risk
Flynn et al. (Lancet, 1971; PMID 4107980): rapid serum-zinc depletion during corticosteroid therapy.
Zinc 15–30 mg daily is a range in common use. Flynn reports serum zinc falling during corticosteroid therapy; that paper is not the source of this dose or form.
Mechanism, Mineralocorticoid activity of corticosteroids increases renal potassium excretion.
Common signs, Muscle weakness, fatigue, cardiac arrhythmia
Glucocorticoids have mineralocorticoid activity that can lower potassium. In a cross-sectional study of 110 outpatients given 1 g of intravenous methylprednisolone daily for 3 days, 18% developed hypokalemia, nearly all of it mild (Tamez-Perez et al., Rev Invest Clin, 2009; PMID 19736807). That was high-dose pulse therapy; the rate on ordinary oral doses was not measured there.
Increased dietary potassium is described, with serum electrolytes monitored together with the prescriber.
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Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
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