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MSK Changes associated with Steroids

- See: Steroid Menu

- Discussion:
    - daily doses of more than 5 to 7.5 mg of prednisone or its equivalent should be avoided because of side effects produced by glucocorticoids, esp
           diminishing of bone mineral content;
           - low dose (5 to 7.5 mg PO qd) may benefit certain pts w/ little risk of morbidity;

- Bone Changes:
    - bone changes following long term corticosteroid administration are same namely, severe osteoporosis;
    - steroids initially produce an increase in bone turn over and a high turnover type osteopenia, which is theorized to occur from steroid inhibition of the osteocyte-osteoblast lining
             cell system, w/ resultant increase in PTH secretion and bone turn over;
    - long term administration of steroids or long term oversecretion of cortisol results in a low turn over type osteopenia;
    - some recommend that patients on long term steroids should also receive appropriate doses of vit D and calcium;
    - also consider use of bisphosphonates (fosamax)

- Steroid Myopathy:
    - administration of high doses of steroids, particularly fluorinated steroids, over protracted periods may lead to proximal weakness;
    - biopsy findings are usually limited to atrophy of type II fibers, which cannot be distinguished from pathologic findings seen in  muscle disuse such as occurs in muscles
             immobilized in a cast; 

Changes associated with Anabolic Steroids:

   - cholesterol:
           - use of anabolic steroids causes a decrease in high-density lipoprotein levels but has no effect on low-density lipoprotein levels;
           - an abnormally low high-density lipoprotein level should alert the physician to the possibility of steroid use in an athlete;
           - ref:
                - Effects of androgenic-anabolic steroids on apolipoproteins and lipoprotein.  
                - Effects of androgenic-anabolic steroids in athletes

Corticosteroid-induced osteoporosis.