Steroid-induced osteoporosis

Steroid-induced osteoporosis (SIOP) is osteoporosis arising due to use of glucocorticoids - analogous to Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug prednisone is a main candidate after prolonged intake. Some professional guidelines recommend prophylaxis 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.^[1] Alternate day use may not prevent this complication.^[2]

Mechanisms of SIOP include:^[3]

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

References

^ Bone and Tooth Society of Great Britain, National Osteoporosis Society, Royal College of Physicians (2003). Glucocorticoid-induced Osteoporosis. London, UK: Royal College of Physicians of London. ISBN 1-860-16173-1. http://www.rcplondon.ac.uk/pubs/contents/966c62dd-8011-4f65-a61d-dd0c7fe4fa4b.pdf.
^ 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 Mars, 2009

Endocrine pathology: endocrine diseases (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, ACTH deficiency/Secondary adrenal insufficiency) · 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	Pseudohypoparathyroidism

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

ovarian: Polycystic ovary syndrome · Premature ovarian failure

testicular: enzymatic (5-alpha-reductase deficiency, 17-beta-hydroxysteroid dehydrogenase deficiency) · Androgen receptor (Androgen insensitivity syndrome)

general: Hypogonadism (Delayed puberty) · Hypergonadism (Precocious puberty)

Height

Gigantism · Dwarfism/Short stature (Laron syndrome, Psychosocial)

Multiple

Autoimmune polyendocrine syndrome (APS1, APS2) · Carcinoid syndrome · Multiple endocrine neoplasia (1, 2A, 2B) · Progeria (Werner syndrome, Acrogeria, Metageria) · Woodhouse-Sakati syndrome

M: END

anat/phys/devp/horm

noco(d)/cong/tumr, sysi/epon

proc, drug (A10/H1/H2/H3/H5)

Osteochondropathy (M80–M94, 730–733)

Osteopathies

Osteitis

endocrine bone disease: Osteitis fibrosa cystica (Brown tumor)

infectious bone disease: Osteomyelitis (Sequestrum, Involucrum) · Sesamoiditis · Brodie abscess · Periostitis

Bone density
and structure

Density / metabolic bone disease	Osteoporosis (Juvenile) · Osteopenia · Osteomalacia

Continuity of bone	Pseudarthrosis · Stress fracture

Other	Fibrous dysplasia (Monostotic, Polyostotic) · Skeletal fluorosis · bone cyst (Aneurysmal bone cyst) · Hyperostosis (Infantile cortical hyperostosis) · Osteosclerosis (Melorheostosis)

Bone resorption

Osteolysis · Hajdu-Cheney syndrome · Ainhum

Ischemia

Avascular necrosis (Osteonecrosis of the jaw)

Other

Paget's disease of bone · Algoneurodystrophy · Hypertrophic pulmonary osteoarthropathy · Nonossifying fibroma

Chondropathies

Chondritis	Relapsing polychondritis

Other	Tietze's syndrome

Both

Osteochondritis	Osteochondritis dissecans

Juvenile osteochondrosis	lower limb: hip (Legg–Calvé–Perthes syndrome) · tibia (Osgood-Schlatter disease, Blount's disease) · foot (Köhler disease, Sever's disease) Scheuermann’s disease upper limb: wrist (Kienbock's disease)

M: BON/CAR

anat(c/f/k/f, u, t/p, l)/phys/devp/cell

noco/cong/tumr, sysi/epon, injr

proc, drug(M5)