Glucocorticoid Induced Osteoporosis

The correct Answer is E


Explanation:

Glucocorticoids are used in the treatment of chronic inflammatory diseases of the lungs, connective tissue, and intestines as well as in transplantation because of their anti-inflammatory effect. When long-term treatment is required, several complications (e.g., cataracts, truncal obesity, skin-thinning, hyperglycemia) may be seen. A particularly disabling complication is bone loss, which can lead to fracture; it can occur with or without the other complications of chronic steroid treatment.

The incidence of steroid-induced osteoporosis is unknown, but it appears to be related to the duration of treatment, half-life of the steroid, and its dose. Risk factors associated with increased bone loss include age, body mass index, and duration of use. Steroid-induced osteoporosis proceeds rapidly in the first 6 months of steroid use and slows thereafter. Trabecular bone and the cortical rim of the vertebral body are most susceptible to the effects of steroids.

Steroids induce bone loss by several mechanisms.

First, they inhibit calcium absorption in the GI tract while enhancing calcium loss in the kidneys. These effects induce secondary hyperparathyroidism, which leads to increased bone resorption.

Second, they lower sex hormone levels through an effect on the gonadotropin levels and a direct effect at the gonadal level, as well as by decreasing adrenal sex steroid synthesis by inhibiting ACTH release.

Third, they have a direct inhibitory effect on osteoblast proliferation, activity, and half-life, leading to decreased bone formation.

Fourth, they induce proximal muscle weakness.

Short-term studies showed that steroid-induced osteoporosis can be prevented or treated by using measures aimed at minimizing the negative effects of steroids on calcium and bone metabolism. Deficiency of sex steroids should be corrected. Physical therapy should be encouraged to prevent steroid-induced myopathy.

Calcium and vitamin D supplementation and diuretics have been used to enhance calcium absorption and minimize calcium loss in urine, thereby preventing secondary hyperparathyroidism. Regular monitoring is recommended to prevent hypercalcemia.

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