Cushing Osteoporosis

Approximately 50% to 60% of patients develop Cushing-induced osteoporosis about 40% present with back pain and 20% will progress to compression fractures of the spine. 

Qassification Idiopathic osteoporosis type 1, occurring in postmenopausal females type 11, occurring in senescent males and females (>70 y). Secondary osteoporosis associated with primary disorders such as Cushing s disease, or induced by drugs, e.g chronic therapy with glucocorticoids or heparin. In these forms, the cause can be eliminated. 

Speciai risk Use with caution in the following situations Nonspecific ulcerative colitis if there is a probability of impending perforation, abscess, or other pyogenic infection diverticulitis fresh intestinal anastomoses hypertension CHF thromboembolitic tendencies thrombophlebitis osteoporosis exanthema Cushing syndrome antibiotic-resistant infections convulsive disorders metastatic carcinoma myasthenia gravis vaccinia varicella diabetes mellitus hypothyroidism, cirrhosis (enhanced effect of corticosteroids). 

Adverse reactions of corticosteroids are frequent with the long-term immunosuppressive regimens which are often needed and include an increased risk of infections, Cushing-like symptoms, hypertension, hyperglycemia, osteoporosis, growth retardation in children and mental reactions such as dysphoria, psychosis and depression. 

Samaras K, Pett S, Gowers A, McMurchie M, Cooper DA. Iatrogenic Cushing s syndrome with osteoporosis and secondary adrenal failure in human immunodeficiency virus-infected patients receiving inhaled corticosteroids and ritonavir-boosted protease inhibitors six cases. J Clin Endocrinol Metab 2005 90(7) 4394-8. 

Corticosteroids should be used cautiously in the presence of congestive heart failure, myocardial infarction, hypertension, diabetes mellitus, epilepsy, glaucoma, hepatic disorders, osteoporosis, peptic ulceration, and renal impairment. Children are more susceptible to these adverse effects. To avoid cardiovascular collapse, steroids must be given slowly by intravenous injection. Large doses produce Cushing s syndrome (with moon face and sometimes hirsutism). 

Over-secretion of the glucocorticoids, particularly cortisol, causes Cushing s disease, with changes in distribution of body fat, muscle wasting and weakness, osteoporosis, immune suppression with frequent infections, poor wound healing and mood changes, which include depression and sometimes paranoia. 

Certaiu medicatious have beeu associated with au iucrease iu osteoporosis risk, particularly steroids and anticonvulsants. Steroid-induced osteoporosis arises due to use of glucocorticoids, analogous to Cushing s syndrome, and involving mainly the axial skeleton prednisone... 

Adrenal insufficiency Cushing s syndrome Peptic ulceration Osteoporosis Hypertension... 

Osteoporosis occurs when bone mass is less than one would expect for the average person of a specific age. Osteoporosis can have many causes. The reduction of the female hormone estrogen after menopause is the most common. Persons who have increased thyroid hormone (hyperthyroid) can become osteoporotic. Patients receiving steroids for long periods of time, either as medication or because of adrenal disease (Cushing s disease) are also at risk. 

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