Time to End Steroid-Induced Fractures Vol. These risks include truncal obesity, thinning of the skin, easy bruising, hypertension, diabetes, adrenal gland suppression, increased susceptibility to infection, cataracts, and osteoporosis. Because of the large number of adverse effects and their potential seriousness, glucocorticoids should always be administered in the lowest possible dose for the shortest time necessary, and be substituted with other therapeutic agents where these exist.
Osteoporosis is one of the most devastating consequences of steroid use.
Vertebral and rib fractures are most common, but the risk of hip fractures is also more than doubled in these patients. 1 Fracture risk is likely to be higher in those who have previously experienced fractures, since this is evidence of a skeleton already unable to cope with the loads placed on it. Therefore, prophylaxis of bone loss must be considered at the time that steroid treatment is begun, particularly in those older than 50 years. In addition to the clinical risk factors mentioned in the previous paragraph, bone density is also an important predictor of fracture and should be assessed in all patients undergoing long-term treatment with steroids. It should be remembered that bone density T score may decrease by as much as 1 during the first year of therapy, so that intervention is appropriate at more positive T scores than those listed above for patients newly beginning treatment with steroids.