A10 SUNDAY, MAY 4, 1997 HEALTH THE SAUNA JOURNAL PERSONAL HEALTH Steroids interfere with calcium and hormones Note to readers: The second portion of this story was omitted from the Health section of Thursday's edition. This is the column in its entirety, Steve Tim of Brooklyn N.Y., is among millions of Americans whose life, or quality of life, depends on continuous treatment with a steroid drug that unfortunately can cause osteoporosis. Tim has a complicated autoimmune disorder that is treated with prednisone, a cor- ticosteroid he must take daily to suppress the runaway immune system that is attacking his blood vessels, joints and hone marrow. But while pred- nisone is protecting those vital body parts, it can also be eating away at Tim's j bones. To help protect those bones from otherwise inevitable decay and possible fractures, Tim's rheumatologist told him to take daily supplements of calcium and vitamin D. According to experts at the American College of Rheumatology, millions of others who must take steroid medications for prolonged periods are unaware of the risk to their bones and are not taking appropriate preventive measures. Without proper protection, within the first sue months of corticos- teroid therapy, a person can lose 10 percent to 20 percent of bone mass. One in four of these people can expect to suffer a fracture as a result. Unlike osteoporosis associated with aging, steroid-induced osteoporosis can occur at any age, even T HEALTH INSURANCE JANE BRODY The New York Times in children. More than 30 million Americans have disorders that may require treatment with corticosteroids. These drugs, which mimic the action of cortisone-like hormones produced by the outer shell of the adrenal gland, are extraordinarily helpful in suppressing the symptoms of a broad spectrum of diseases. Steroids are essential to the treatment of many chronic inflammatory and autoimmune diseases, including chronic severe asthma, rheumatoid arthritis and other connective tissue diseases, chronic obstructive lung disease, inflammatory bowel disease, lupus and multiple sclerosis. Transplant patients usually depend on steroids to prevent rejection of the transplanted tissue. Steroids are also often used for shorter periods to treat acute inflammation and severe allergic reactions. The drugs can be taken by mouth, injection or inhalation or they can be incorporated into drops or applied topically in a lotion or cream. They typically impair bone health only when taken orally or by injection on a regular basis. But while it was long thought that only high doses of steroids were a problem, more recent studies have shown that chronic use of low oral doses — as little as 7.5 milligrams a day — can also cause gradual bone loss. Commonly used oral steroids (with brand names in parentheses) include betamethasone (Celestone), cortisone, dexamethasone (Dala- lone, Decadron, Dexacen, Dexone), hydrocortisone (Cortef, Hydrocor- tone), methylprednisolone (Medrol, Medralone), prednisolone (Pred- alone, Predcor, Predicort), pred- nisone (Orasone, Deltasone) and tri- amcinolone (Aristocort, Cenocort, Rising co-payments raise care questions New study of HMOs: higher co-payments, flat fees, guidelines By LAURA MECKLER The Associated Press WASHINGTON — Pressure to keep premiums low has driven up co-payments for patients in health maintenance organizations, a new study reports. Increasing co-payments for everything from drugs to hospital stays decreases premiums, partly because the higher prices discourage people from using their health care, said Jon Gabel, whose study is published in the May/June issue of Health Affairs. The study examining HMO trends also concludes: • More doctors are being paid a flat fee for each patient no matter how much care is given, providing a financial incentive to give less care. In 1989, 35 percent of HMO doctors were paid flat fees; by 1994, it was 50 percent. • Practice guidelines which sug- gest treatments for various illnesses have become more prevalent. In 1989, 30 organizations had published 700 sets of guidelines. Today, 75 organizations have issued 1,800 sets, and three out of four HMOs use formally written practice guidelines. The study also found that between 1987 and 1993, consumer payments increased for a variety of services: • The average payment for a doctor's visit went from $1.18 to $4.51. • Co-payments for hospital stays rose from $4.50 per day to $24.90 per day. • Drug costs rose from $3.90 per prescription to $4.60 each. • Co-payments for inpatient mental health care services rose from $3.39 per day to $14.51 per day. Patients required to make a co- payment for care are likely to use fewer services, Gabel said. But out-of-pocket costs for HMO customers are still significantly less than those in traditional plans, where patients often pay a deductible in addition to 20 percent of the total bill. Is your lawn chemically dependent? Many lawns now depend on constant fixes from chemical lawn services. If you use all-natural Liiwns Alit'i'.', you only have to feed your soil twice a year to keep your grass lush and green. And you create a healthy habitat for children and pets to enjoy. $5.00 Off 40 Ib. bag I^twns Alive! 05/31/97 I Wild Bird Crossing Your ultimate backyard nature store™ Galaxy Shopping Center • Salina 2306 Planet Avenue Mon.-Sat. 1Q-6, Sun. 1-5 (913) 452-WILD Now your local source for Gardens Alive! products Kenalog, Trilog, Trilone). Steroids hurt bones in a number of ways. They interfere with calcium, reducing the amount of calcium the body absorbs from foods and increasing the loss of calcium through the kidneys. This lowers the level of calcium in the blood, a situation the body must instantly correct. When the blood level of calcium falls, parathyroid hormone is released to remove calcium from storage in the bone and restore a normal level. Steroids also cause bone breakdown. Although it may appear solid, bone is really a tissue constantly being broken down and built up. Steroids stimulate the action of os- teoclasts, cells that break down bone, and inhibit the action of os- teoblasts, cells that build new bone. As a result, buildup of bone cannot keep up with breakdown. They reduce production of sex hormones. Just as estrogen is important to bone health in women, testosterone is important to bone health in men. Steroids suppress both estrogen and testosterone, and that reduces bone density. Last fall, the American College of Rheumatology issued guidelines to help prevent osteoporosis in patients who get long-term steroid treatment. Although rheumatolo- gists should be well schooled in the problem and how to cope with it, the college noted that many patients using steroids were under the care of primary-care doctors who might be unaware of the hazard or what to do about it. The college urged doctors to use topical or inhaled steroid preparations wherever feasible and to always prescribe the lowest effective dose. The guidelines cautioned that although low doses of inhaled steroids are not a problem, high doses can result in bone loss. % A.EY.' Were celebrating our customers with a fantastic Ct> offer, 24-Month Ct> deposits of $10,000 or move. To take advantage of ou.r special offer, visit the First Bank Kansas location nearest you.. 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