E1 ReplicatedModerate confidencePEM not requiredRCTPeer-reviewedMachine draft
Decreased bone mineral density during low dose glucocorticoid administration in a randomized, placebo controlled trial.
McKenzie, R, Reynolds, J C, O'Fallon, A et al. · The Journal of rheumatology · 2000
Quick Summary
This study tested whether a low dose of the steroid medication hydrocortisone affected bone density in people with ME/CFS over 12 weeks. Researchers found that patients taking the steroid experienced a slight decrease in bone mineral density in their spine, while those taking a placebo did not. This suggests that even low doses of steroids may weaken bones over time.
Why It Matters
This study is important because some ME/CFS patients have been treated with low-dose steroids, and understanding their bone health effects is critical for safe treatment decisions. The finding that even low steroid doses reduce bone density suggests clinicians and patients should carefully weigh risks and benefits and consider bone-protective interventions during glucocorticoid therapy for ME/CFS.
Observed Findings
- Lateral spine BMD decreased by 2.0% in the hydrocortisone group compared to a 1.0% increase in the placebo group (p=0.03).
- Anteroposterior spine BMD decreased by 0.8% in the hydrocortisone group compared to a 0.2% increase in the placebo group (p=0.06).
- The hydrocortisone dose ranged from 25–35 mg/day (equivalent to approximately 7.5 mg prednisone/day).
- Twenty-three subjects completed the study (19 women, 4 men), with 11 receiving hydrocortisone and 12 receiving placebo.
Inferred Conclusions
- Low-dose glucocorticoid therapy is associated with measurable decreases in lumbar spine bone mineral density over 12 weeks.
- Bone density loss occurs even at doses lower than typical anti-inflammatory glucocorticoid regimens (7.5 mg prednisone equivalent).
- Ambulatory ME/CFS patients receiving hydrocortisone may warrant monitoring of bone health and consideration of bone-protective measures.
Remaining Questions
- What is the clinical significance of a 2% bone density loss—does it correlate with increased fracture risk in ME/CFS patients?
- Does bone density recover after discontinuation of low-dose hydrocortisone, or is the loss permanent?
- How do long-term low-dose steroid effects differ from the 12-week effects observed in this study?
What This Study Does Not Prove
This study does not establish that low-dose hydrocortisone causes clinically significant fractures or long-term bone damage in ME/CFS patients, nor does it prove that steroid treatment is contraindicated for all patients. The 12-week timeframe is relatively short, and bone density changes may not fully predict fracture risk. The study was conducted in ambulatory patients and may not generalize to more severely affected individuals.
Tags
Symptom:Fatigue
Method Flag:PEM Not DefinedWeak Case DefinitionSmall Sample
Metadata
- PMID
- 10990237
- Review status
- Machine draft
- Evidence level
- Replicated human evidence from multiple independent studies
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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