Review Question - QID 101958

The patient described in the vignette above has a history of chronic corticosteroid use, putting her at increased risk of developing osteoporosis.

Patients on long-term corticosteroids can develop a Cushingoid appearance that includes central obesity, thin extremities, purple abdominal striae, round “moon” facies, and hirsutism (Illustration A). Other side effects include muscular weakness and osteoporosis. Osteoporosis results from decreased mineralization and synthesis of osteoid, decreased vitamin D mediated intestinal calcium absorption, and elevated parathyroid hormone. Osteoporosis is a common cause of pathologic fractures.

A clinical practice review article by Weinstein explains that the most common cause of secondary osteoporosis is glucocorticoid therapy. The primary presenting symptom is a pathologic fracture, occurring in up to 50% of patients on long-term glucocorticoid therapy. Osteoporosis from chronic glucocorticoid usage primarily affects cancellous bone such as the lumbar spine and proximal femur.

Ruiz-Irastorza et al. describe that serious side effects of glucocorticoids include: "osteoporosis, osteonecrosis, cataracts, hyperglycaemia, coronary heart disease and cognitive impairment.” They have found that patients receiving less than 7.5 mg of prednisone daily have a minimized profile of side effects.

Illustration A demonstrates an example of hirsutism resulting from chronic corticosteroid treatment.

Incorrect answers:
Answer 1: Hirsutism, not hair loss, is a side effect of chronic corticosteroid therapy.
Answer 2: Weight gain, not weight loss, is a side effect of chronic corticosteroid therapy.
Answer 3: Pancreatic insufficiency is not recognized as a side effect of chronic corticosteroid therapy.
Answer 4: Diastolic, not systolic, hypertension is associated with chronic steroid use.