Prevention and management of glucocorticoid-induced side effects: A comprehensive review : A review of glucocorticoid pharmacology and bone health - 18/04/17

Doi : 10.1016/j.jaad.2016.01.062

Avrom Caplan, MD ^a,^c, Nicole Fett, MD ^b, Misha Rosenbach, MD ^a,^c, Victoria P. Werth, MD ^a,^c, Robert G. Micheletti, MD ^a,^c,^⁎
^a Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
^c Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
^b Department of Dermatology, Oregon Health and Science University, Portland, Oregon

^∗Correspondence to: Robert G. Micheletti, MD, Departments of Dermatology and Medicine, University of Pennsylvania, 2 Maloney Bldg, 3400 Spruce St, Philadelphia, PA 19107.Departments of Dermatology and MedicineUniversity of Pennsylvania2 Maloney Bldg3400 Spruce StPhiladelphiaPA19107

Abstract

Systemic glucocorticoids are an essential therapy for a range of conditions, but their multiple side effects can produce significant morbidity for patients. The objective of this review is to discuss these side effects while addressing 3 questions: 1) What dose and duration of glucocorticoid therapy should prompt concern for individual side effects?; 2) How should clinicians counsel patients about these complications?; and 3) How can these problems be prevented or managed? To accomplish these objectives, we have created a series of tables and algorithms based on a review of relevant data to guide counseling, prophylaxis, and management of 11 glucocorticoid side effects. The first article in this 4-part continuing medical education series begins with a review of glucocorticoid pharmacology followed by a discussion of bone health (ie, osteoporosis and osteonecrosis).

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Key words : glucocorticoids, medication monitoring, osteonecrosis, osteoporosis, pharmacology, side effects, steroids

Plan

Glucocorticoid pharmacology

Dose and duration

Glucocorticoid-induced osteoporosis

Background

Epidemiology and risk factors

Evaluation

Prevention and treatment

Treatment

Osteonecrosis

Background

	Funding sources: None.
	Conflicts of interest: None declared.
	Please note that infectious and other complications of steroid use will be discussed in the third and fourth installments of this Continuing Medical Education feature in the February 2017 issue of the JAAD.
	Date of release: January 2017
	Expiration date: January 2020