All clinician resources
Monitoring & safety
Steroid Tapering and Bone Protection
Reducing glucocorticoid harm in patients who need prednisone.
Video lesson
Key points
Prolonged use above about 5 mg prednisone daily raises fracture, infection, diabetes, cataract and cardiovascular risk. HPA suppression is likely after 3 weeks at 20 mg or more daily.
Practical approach
Taper by larger steps at higher doses and smaller steps below 10 mg. Start calcium and vitamin D for anyone expected to take 2.5 mg or more for 3 months, assess fracture risk with FRAX adjusted for steroid dose, and treat with a bone agent when risk is moderate or high.
Pearls
Steroid-sparing strategies (methotrexate in PMR, tocilizumab in GCA) are worth discussing early.
At a glance
Category
Monitoring & safety
Reviewed by Farhan Tahir, MD, FACR
Questions about your own care?
Book an in-person or telehealth consultation with Dr. Tahir.
For education only. Don’t start, stop or change a medicine without talking to your care team.