D. Avascular necrosis – Explanation

Long-term corticosteroid use is linked to osteopaenia and osteoporosis, rather than osteomalacia.

Corticosteroids
Corticosteroids are amongst the most commonly prescribed therapies in clinical practice. They are

used both systemically (oral or intravenous) or locally (skin creams, inhalers, eye drops, intra-
articular). They augment and in some cases replace the natural glucocorticoid and mineralocorticoid

activity of endogenous steroids.
The relative glucocorticoid and mineralocorticoid activity of commonly used steroids is shown below:

Side-effects
The side-effects of corticosteroids are numerous and represent the single greatest limitation on their
usage. Sideeffects are more common with systemic and prolonged therapy.

Glucocorticoid side-effects

• endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia
• Cushing’s syndrome: moon face, buffalo hump, striae
• musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of the femoral head
• immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis
• psychiatric: insomnia, mania, depression
• gastrointestinal: peptic ulceration, acute pancreatitis
• ophthalmic: glaucoma, cataracts
• suppression of growth in children

Mineralocorticoid side-effects

• fluid retention
• hypertension

Selected points on the use of corticosteroids:

• patients on long-term steroids should have their doses doubled during intercurrent illness
• the BNF suggests gradual withdrawal of systemic corticosteroids if patients have: received more
  than 40mg prednisolone daily for more than one week, received more than 3 weeks treatment or
  recently received repeated courses