Steroid-induced osteoporosis

Steroid-induced osteoporosis (SIOP) is osteoporosis arising due to use of glucocorticoids (steroid hormones) - analogous to Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug prednisone is a main candidate after prolonged intake. Bisphosphonates are beneficial in reducing the risk of vertebral fractures.^[1] Some professional guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take the equivalent of more than 30 mg hydrocortisone (7.5 mg of prednisolone), especially when this is in excess of three months.^[2]^[3] The use of thiazide diuretics, and gonadal hormone replacement has also been recommended, with the use of calcitonin, bisphosphonates, sodium fluoride or anabolic steroids also suggested in refractory cases.^[4] Alternate day use may not prevent this complication.^[5]

Mechanisms of SIOP include:^[6]

Direct inhibition of osteoblast function
Direct enhancement of bone resorption
Inhibition of gastrointestinal calcium absorption
Increased urine calcium loss
Inhibition of sex steroids

References

↑ Allen, CS; Yeung, JH; Vandermeer, B; Homik, J (5 October 2016). "Bisphosphonates for steroid-induced osteoporosis.". The Cochrane database of systematic reviews. 10: CD001347. PMID 27706804. |access-date= requires |url= (help)
↑ Bone and Tooth Society of Great Britain, National Osteoporosis Society, Royal College of Physicians (2003). Glucocorticoid-induced Osteoporosis (PDF). London, UK: Royal College of Physicians of London. ISBN 1-86016-173-1.
↑ Cochrane Reviews. [url=http://summaries.cochrane.org/CD000952/calcium-and-vitamin-d-for-treating-osteoporosis-caused-by-the-use-of-steroids "Calcium and vitamin D for treating osteoporosis caused by the use of steroids"]
↑ Lukert, Barbara P. (1 March 1990). "Glucocorticoid-Induced Osteoporosis: Pathogenesis and Management". Annals of Internal Medicine. 112 (5): 352. doi:10.7326/0003-4819-112-5-352.
↑ Gourlay M, Franceschini N, Sheyn Y (2007). "Prevention and treatment strategies for glucocorticoid-induced osteoporotic fractures". Clin Rheumatol. 26 (2): 144–53. doi:10.1007/s10067-006-0315-1. PMID 16670825.
↑ Steroid-induced osteoporosis By Susan Ott, MD. Updated January 28, 2009. Retrieved on 26 March 2009

Diseases of the endocrine system (E00–E35, 240–259)

Pancreas/
glucose
metabolism

Hypofunction	Diabetes mellitus types: type 1 type 2 MODY 1 2 3 4 5 6 complications coma angiopathy ketoacidosis nephropathy neuropathy retinopathy cardiomyopathy insulin receptor (Rabson–Mendenhall syndrome) Insulin resistance

Hyperfunction	Hypoglycemia beta cell (Hyperinsulinism) G cell (Zollinger–Ellison syndrome)

Hypothalamic/
pituitary axes

Hypothalamus

gonadotropin
- Kallmann syndrome
- Adiposogenital dystrophy
CRH (Tertiary adrenal insufficiency)
vasopressin (Neurogenic diabetes insipidus)
general (Hypothalamic hamartoma)

Pituitary

Hyperpituitarism	anterior Acromegaly Hyperprolactinaemia Pituitary ACTH hypersecretion posterior (SIADH) general (Nelson's syndrome)

Hypopituitarism	anterior Kallmann syndrome Growth hormone deficiency Hypoprolactinemia ACTH deficiency/Secondary adrenal insufficiency GnRH insensitivity FSH insensitivity LH/hCG insensitivity posterior (Neurogenic diabetes insipidus) general Empty sella syndrome Pituitary apoplexy Sheehan's syndrome Lymphocytic hypophysitis

Thyroid

Hypothyroidism	Iodine deficiency Cretinism Congenital hypothyroidism Myxedema Euthyroid sick syndrome

Hyperthyroidism	Hyperthyroxinemia Thyroid hormone resistance Familial dysalbuminemic hyperthyroxinemia Hashitoxicosis Thyrotoxicosis factitia Graves' disease

Thyroiditis	Acute infectious Subacute De Quervain's Subacute lymphocytic Autoimmune/chronic Hashimoto's Postpartum Riedel's

Goitre	Endemic goitre Toxic nodular goitre Toxic multinodular goiter Thyroid nodule

Parathyroid

Hypoparathyroidism	Hypoparathyroidism Pseudohypoparathyroidism Pseudopseudohypoparathyroidism

Hyperparathyroidism	Primary Secondary Tertiary Osteitis fibrosa cystica

Adrenal

Hyperfunction	aldosterone: Hyperaldosteronism/Primary aldosteronism Conn syndrome Bartter syndrome Glucocorticoid remediable aldosteronism AME Liddle's syndrome 17α CAH cortisol: Cushing's syndrome (Pseudo-Cushing's syndrome) sex hormones: 21α CAH 11β CAH

Hypofunction/ Adrenal insufficiency (Addison's, WF)	aldosterone: Hypoaldosteronism 21α CAH 11β CAH cortisol: CAH Lipoid 3β 11β 17α 21α sex hormones: 17α CAH

Gonads

general: Hypogonadism (Delayed puberty)
Hypergonadism
- Precocious puberty
Hypoandrogenism
Hypoestrogenism
Hyperandrogenism
Hyperestrogenism
Postorgasmic illness syndrome

Height

Multiple

Autoimmune polyendocrine syndrome multiple
- APS1
- APS2
Carcinoid syndrome
Multiple endocrine neoplasia
- 1
- 2A
- 2B
Progeria
Woodhouse-Sakati syndrome

Bone and joint disease (M80–M94, 730–733)

Bone

Inflammation

endocrine:	Osteitis fibrosa cystica Brown tumor

infection:	Osteomyelitis Sequestrum Involucrum Sesamoiditis Brodie abscess Periostitis Vertebral osteomyelitis

Metabolic

Bone resorption

Other

Joint

Chondritis	Relapsing polychondritis

Other	Tietze's syndrome

Combined

Osteochondritis

Osteochondritis dissecans

Child

leg:	hip Legg–Calvé–Perthes syndrome tibia Osgood-Schlatter disease Blount's disease foot Köhler disease Sever's disease

spine	Scheuermann’s disease

arm:	wrist Kienbock's disease elbow Panner disease

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