Osteoporosis glucocorticoids, systemic

Steroids have mineralocorticoid and glucocorticoid effects. Betamethasone has little, if any, mineralocorticoid effect. However, it should be used with caution in patients predisposed to hypertension since mineralocorticoid effects may lead to sodium and water retention and an increase in blood pressure. When used systemically, especially at high doses, steroid therapy is associated with a risk of psychiatric reactions such as euphoria, irritability, mood lability and sleep disorders. Glucocorticoid side-effects include diabetes and osteoporosis. 

Oral glucocorticoids such as dexamethasone and prednisolone are still used in patients with severe asthma, though these agents are associated with adverse systemic effects such as growth retardation, osteoporosis, and the suppression of hypothalamic-pituitary adrenal function and the immune system. 

Horses appear to be more sensitive to the adrenosuppressive effects of aerosolized corticosteroids than human patients. Documentation of systemic absorption (adrenal suppression) of inhaled beclometasone and fluticasone raises concerns that other systemic glucocorticoid effects may occur following aerosol administration of corticosteroids. The administration of adrenosuppressive doses (>1600 p,g/day) of beclometasone dipropionate to asthmatic human patients does not produce the other systemic side-effects of glucocorticoid administration, including a roimd face (Cushingoid facies), polyuria, polydipsia, hyperglycemia, obesity, altered carbohydrate metabolism, osteoporosis, abortion, posterior subcapsular cataract and aseptic necrosis of the... 

In most studies, patients with rheumatoid arthritis have lower BMD and more fractures than do age-matched controls.Common disease pathways, inclnding proinflammatory cytokines and the OPG/RANK/RANKL system, may be responsible along with increased glucocorticoid use, hypogonadism, decreased activity, and increased fall risk. Patients taking glucocorticoids should be managed with calcium and vitamin D snpplementation plus a bisphosphonate. Otherwise, standard osteoporosis prevention and treatment interventions are recommended. 

Osteoporosis can be categorized as primary (idiopathic) or secondary to a systemic illness or medication such as glucocorticoids or phenytoin. A major factor in the former category is the decline in estrogen levels, and the resulting sharp decrease in bone mass that accompanies menopause in women. 

E. Glucocorticoids The glucocorticoids have several effects already referred to (eg, protein catabolism see Chapter 39) that inhibit bone mineral maintenance. As a result, chronic systemic use of these drugs is a common cause of osteoporosis in adults. However, these hormones are useful in the intermediate-term treatment of hypercalcemia. 

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