When you have completed both, mail or fax to the American Medical Association. Mailing and faxing instructions appear on the following page. Your CME certificate will arrive in 2 to 3 weeks. Exam Introduction 1.
Glucocorticoids have a direct effect through their action on osteoblasts and osteoclasts.
Glucocorticoids inhibit the replication of osteoblasts, decrease the genesis of new osteoblasts, and induce apoptosis in osteoblasts. Most patients taking glucocorticoids experience impaired intestinal absorption of calcium in conjunction with increased renal excretion of calcium. Glucocorticoids may increase the activity or secretion of parathyroid hormone through their effect on calcium absorption and excretion. Glucocorticoids increase the sensitivity of osteoclasts and osteoblasts to parathyroid hormone, which has a direct effect on bone turnover. Glucocorticoids decrease pituitary production of luteinizing hormone, which in turn leads to decreased production of estrogen in women and testosterone in men.