Long-term use of high-dose steroid tablets is a recognised risk factor for osteoporosis (thinner bones that break more easily), and rheumatoid arthritis itself also raises that risk. Ask your GP or rheumatology team about bone protection, whether you need a bone density (DEXA) scan, vitamin D and calcium, and falls prevention. Never stop, skip or lower steroid tablets yourself — that can be dangerous. Follow your team's plan for any bone-strengthening medicines they prescribe.
This guide is for one job: the questions to ask about bones when you take steroids for arthritis, especially if you are older or living with frailty. For infection warning signs on steroids, see our steroids and infection guide. For the red and blue steroid cards, see our steroid emergency card guide. Hand off early to the bone density and osteoporosis guide for the wider condition picture.
Why steroids and inflammatory arthritis affect bones
The NHS lists long-term use of high-dose steroid tablets — widely used for conditions such as arthritis and asthma — among the factors that increase the risk of osteoporosis and broken bones. Rheumatoid arthritis is listed separately as a risk factor. The NHS also says taking prednisolone for a long time can lead to thinner bones (osteoporosis).
Osteoporosis develops slowly and is often only noticed when a fall or sudden impact causes a fracture. Common breaks include the wrist, hip and bones of the spine. That is why bone protection and falls prevention belong in the same conversation as your steroid plan — not instead of it.
Questions to take to your GP or rheumatology team
- Do I need bone-protection medicine while I am on steroids, and for how long?
- Should I have a bone density (DEXA) scan, and when will we repeat it?
- Have you checked my fracture risk (tools such as FRAX or Q-Fracture are sometimes used)?
- What vitamin D and calcium plan do you want for me?
- Who reviews my steroid dose, and what is my sick-day plan if I am unwell?
- Do I need a red NHS Steroid Emergency Card or a blue steroid treatment card?
Bring a full medicines list, including recent joint injections, inhalers and nasal sprays. Our steroids for arthritis guide explains how steroids are used. Do not stop, skip or lower your steroid dose yourself.
Bone density scans in plain words
A DEXA scan measures bone strength. It is a short, painless test, usually 10 to 20 minutes. Results are often given as a T-score compared with a healthy young adult. Broadly, the NHS describes a T-score above −1 as normal, between −1 and −2.5 as osteopenia (bone loss that is not yet osteoporosis), and below −2.5 as osteoporosis. Only your clinician can interpret your result and decide on treatment. Osteopenia does not always become osteoporosis.
Vitamin D and calcium — food first, then the NHS winter advice
- The NHS says adults need about 700mg of calcium a day from food where possible: dairy, leafy green vegetables, dried fruit and tofu are common sources
- Vitamin D helps your body use calcium. Between October and early March, the NHS says everyone should consider a daily supplement containing 10 micrograms (400 IU) of vitamin D, because UK sunlight is too weak
- Consider vitamin D all year if you are frail or housebound, live in a care home, usually cover your skin outdoors, or have dark skin
- For most people, 10 micrograms a day is enough. Adults should not take more than 100 micrograms (4,000 IU) a day unless a doctor advises it
- Check labels so you do not double up with multivitamins or calcium tablets that already contain vitamin D
Our vitamin D winter guide covers the full NHS framing. Vitamin D supports bones and muscles; it is not a treatment for arthritis itself.
Falls prevention protects bones you already have
Stronger bones still break if you fall. The NHS advises staying active, wearing well-fitting non-slip shoes, using a personal alarm or phone, decluttering trip hazards, and asking a GP or pharmacist if medicines could affect your balance. Strength and balance exercise helps; see the exercise hub and falls prevention guide. In winter, plan outdoor trips carefully — our ice and snow guide has practical steps.
Call 999 after a fall if you cannot get up, may have injured your head, neck, back or hip, or have severe hip or groin pain. For urgent advice when you are unsure, contact NHS 111.
Never stop steroids to "protect your bones"
Bone protection sits alongside steroid treatment. Stopping prednisolone suddenly can be dangerous, especially after a high dose for a long time, because your own adrenal glands may not make enough cortisol. Keep any steroid cards with you, agree sick-day rules with your team, and use your flare action plan. Infection on steroids needs early action — see our infection watch guide.
If you care for someone on steroids
- Know whether they have been offered bone protection and a DEXA scan
- Help them remember vitamin D in autumn and winter (and all year if housebound)
- Keep paths clear, night lights on, and walking aids within reach
- Ask for a carer's assessment if medicines, shopping or falls worry you
When to get help
- See your GP if you take steroids long term and have never discussed bone health, or you have new bone pain, height loss or a stooped posture
- See your GP after any fall, even if you got up
- Call 999 for a fall with possible hip, head or spine injury, or if you cannot get up
- Contact NHS 111 for urgent advice when you are unsure
Frequently asked questions
Do steroid joint injections thin bones the same way?
Repeated steroid injections can add up with tablets and other steroid types. Ask your team whether your pattern of injections changes your bone-protection plan. Do not refuse a needed injection without a clinical discussion.
Is osteopenia the same as osteoporosis?
No. Osteopenia means bone density is lower than average for your age but not low enough to be called osteoporosis. Your clinician decides whether you need treatment based on your overall fracture risk, not the label alone.
Can I take extra vitamin D instead of bone-protection tablets?
No. Follow the dose your team advises. More vitamin D is not better and can be harmful above the NHS adult upper limit without medical advice. Bone-strengthening medicines, when prescribed, are a separate decision.
Sources and further reading
- NHS: Causes of osteoporosis (steroids and rheumatoid arthritis)
- NHS: Osteoporosis overview
- NHS: Preventing osteoporosis
- NHS: Side effects of prednisolone (thinner bones)
- NHS: Vitamin D
- NHS: Falls
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Bone density and osteoporosis — wider guide
- Steroid emergency cards — red and blue cards
- Steroids and infection — warning signs
- Vitamin D in winter — NHS 10 microgram advice
- Steroids for arthritis — how they are used
- Falls prevention — protect bones you have
- Ice and snow — winter falls
- Exercise hub — strength and balance
- Flare action plan — write steroid questions down
- Rheumatoid arthritis — condition hub