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Corticosteroids

What Are Corticosteroids?

Corticosteroids are medications often used to treat inflammatory diseases that affect more than 30 million Americans, such as asthma, chronic lung disease, rheumatoid arthritis and other connective tissue diseases, and inflammatory bowel disease.

Corticosteroids, often referred to as steroids, are related to cortisol, a naturally produced hormone that controls many important body functions. Corticosteroids are different from anabolic steroids, which are used by some athletes.

In normal amounts, corticosteroids play an important role in the regulation of blood sugar levels, salt and water, and in metabolism and growth. They also reduce the activity of the body's immune system and act to suppress allergic reactions.

Corticosteroids are used to decrease the inflammation that causes the pain, redness and swelling associated with inflammatory diseases. They are effective in the management of these diseases and improve patients' quality of life. Osteoporosis is a potential and significant side effect and bone mass must be carefully monitored during treatment with these medications.

How Are Corticosteroids Taken?

Corticosteroids are administered in a number of ways: orally, with tablets, or by injection into the joints (e.g., for arthritis); by inhaler (e.g., for asthma); as topical applications (e.g., creams for skin disorders); as drops (e.g., for eye or ear disease); or less commonly, by intravenous injection (e.g., for multiple sclerosis or after organ transplantation).

How Do Corticosteroids Affect Bone Mass?

Bone loss increases with the dose and duration of corticosteroid treatment. The adverse effects of steroids on the skeleton can occur even with intermittent use of these drugs.

Abnormally high levels of corticosteroids interfere with the bone remodeling process and calcium regulation by:

     Decreasing the amount of calcium absorbed from food and increasing the loss of calcium in the urine. This stimulates overproduction of the parathyroid hormone, which works to maintain the level of calcium in the blood by moving calcium in or out of the skeleton, where it is stored.

     Exerting a direct effect on the cells responsible for bone maintenance, stimulating osteoclasts (which break down bone) and inhibiting osteoblasts (which build bone).

     Reducing the production of estrogen in women and testosterone in men, both of which play an important role in the maintenance of bone density.

     Inhibiting skeletal growth and development in children and causing rapid and severe bone loss in adults.

The degree of bone loss is such that, if taken in high doses, corticosteroids can cause fractures in less than a year. The bones in the spine, ribs, and wrist are most susceptible to the effects of corticosteroids.

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