Which types of health education would a nurse provide to a patient who is on corticosteroid therapy

Preventing re-hospitalization is a huge responsibility, especially in consideration of costly penalties that are levied for early readmissions. To accomplish this, nurses need to constantly improve patient teaching and education prior to discharge. Some of the things nurses can do to advance patient education include:

  • Delegate more responsibilities to support staff and be more focused on patient education.
  • Begin educating patients with every encounter from admission.
  • Find out what the patient already knows. Correct any misinformation.
  • Feed patients information in layman’s terms. Utilize visual aids as often as possible.
  • Question their understanding of the care, and plan for the next lesson.
  • Use return demonstration when administering care. Involve the patient from the very first treatment.
  • Ask the patient to tell you how they would explain (step-by-step) their disease or treatment to their loved one.
  • Make sure the patient understands the medications as you administer them. Make sure they understand how and when to refill medications.
  • Provide patients with information about signs and symptoms of their condition that will require immediate attention.

Five strategies for patient education success

Teaching patients is an important aspect of nursing care. Whether teaching a new mom how to bathe a newborn baby or instructing an adult who is living with a chronic heart disease, a successful outcome depends on the quality of the nurse’s instruction and support. Consider these five strategies.

1. Take advantage of educational technology

Technology has made patient education materials more accessible. Educational resources can be customized and printed out for patients with the touch of a button. Make sure the patient’s individualized needs are addressed. Don't simply hand the patient a stack of papers to read, review them with patients to ensure they understand the instructions and answer questions that arise. Some resources are available in several languages.

2. Determine the patient’s learning style

Similar information may be provided by a range of techniques. In fact, providing education using different modalities reinforces teaching. Patients have different learning styles so ask if your patient learns best by watching a DVD or by reading. A hands on approach where the patient gets to perform a procedure with your guidance is often the best method.

3. Stimulate the patient’s interest

It's essential that patients understand why this is important. Establish rapport, ask and answer questions, and consider specific patient concerns. Some patients may want detailed information about every aspect of their health condition while others may want just the facts, and do better with a simple checklist.

4. Consider the patient’s limitations and strengths

Does the patient have physical, mental, or emotional impairments that impact the ability to learn? Some patients may need large print materials and if the patient is hearing impaired, use visual materials and hands on methods instead of simply providing verbal instruction. Always have patients explain what you taught them. Often people will nod “yes” or say that they comprehend what is taught even if they have not really heard or understood. Consider factors such as fatigue and the shock of learning a critical diagnosis when educating patients.

5. Include family members in health care management

Involving family members in patient teaching improves the chances that your instructions will be followed. In many cases, you will be providing most of the instruction to family members. Families play a critical role in health care management.

Teaching patients and their families can be one of the most challenging, yet also rewarding elements of providing nursing care. First-rate instruction improves patient outcomes dramatically.

The value of patient education resources

For further resources that will strength your organization’s patient-teaching, let Lippincott Advisor help. Our best-in-class, evidence-based decision support software for institutions includes over 16,000 customizable patient teaching handouts and content entries.

  1. National Institute for Health and Clinical Excellence (NICE): Clinical Knowledge Summaries: Corticosteroids - Oral. 2012, NICE, [http://www.cks.nhs.uk/corticosteroids_oral], Accessed February 20, 2013

    Google Scholar 

  2. Singh N, Rieder MJ, Tucker MJ: Mechanisms of glucocorticoid-mediated antiinflammatory and immunosuppressive action. Paed Perinatal Drug Ther. 2004, 6: 107-115.

    CAS  Google Scholar 

  3. Newton R, Leigh R, Giembycz MA: Pharmacological strategies for improving the efficacy and therapeutic ratio of glucocorticoids in inflammatory lung diseases. Pharmacol Ther. 2010, 125: 286-327. 10.1016/j.pharmthera.2009.11.003.

    CAS  PubMed  Google Scholar 

  4. Coutinho AE, Chapman KE: The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011, 335: 2-13. 10.1016/j.mce.2010.04.005.

    PubMed Central  CAS  PubMed  Google Scholar 

  5. Croxtall JD, van Hal PT, Choudhury Q, Gilroy DW, Flower RJ: Different glucocorticoids vary in their genomic and non-genomic mechanism of action in A549 cells. Br J Pharmacol. 2002, 135: 511-519. 10.1038/sj.bjp.0704474.

    PubMed Central  CAS  PubMed  Google Scholar 

  6. Smoak KA, Cidlowski JA: Mechanisms of glucocorticoid receptor signaling during inflammation. Mech Ageing Dev. 2004, 125: 697-706. 10.1016/j.mad.2004.06.010.

    CAS  PubMed  Google Scholar 

  7. Stellato C: Post-transcriptional and nongenomic effects of glucocorticoids. Proc Am Thorac Soc. 2004, 1: 255-263. 10.1513/pats.200402-015MS.

    PubMed  Google Scholar 

  8. Furst DE, Saag KG: Up To Date 2012. Determinants of glucocorticoid dosing. 2013,http://www.uptodate.com/contents/determinants-of-glucocorticoid-dosing?source=search_result&search=glucocorticoid&selectedTitle=4~150,

    Google Scholar 

  9. Deshmukh CT: Minimizing side effects of systemic corticosteroids in children. Indian J Dermatol Venereol Leprol. 2007, 73: 218-221. 10.4103/0378-6323.33633.

    CAS  PubMed  Google Scholar 

  10. Da Silva JA, Jacobs JW, Kirwan JR, Boers M, Saag KG, Inês LB, de Koning EJ, Buttgereit F, Cutolo M, Capell H, Rau R, Bijlsma JW: Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis. 2006, 65: 285-293. 10.1136/ard.2005.038638.

    PubMed Central  CAS  PubMed  Google Scholar 

  11. Weinstein RS, Jilka RL, Parfitt AM, Manolagas SC: Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone. J Clin Invest. 1998, 102: 274-282. 10.1172/JCI2799.

    PubMed Central  CAS  PubMed  Google Scholar 

  12. Yao W, Cheng Z, Busse C, Pham A, Nakamura MC, Lane NE: Glucocorticoid excess in mice results in early activation of osteoclastogenesis and adipogenesis and prolonged suppression of osteogenesis: a longitudinal study of gene expression in bone tissue from glucocorticoid-treated mice. Arthritis Rheum. 2008, 58: 1674-1686. 10.1002/art.23454.

    PubMed Central  CAS  PubMed  Google Scholar 

  13. Manolagas SC: Corticosteroids and fractures: a close encounter of the third cell kind. J Bone Miner Res. 2000, 15: 1001-1005. 10.1359/jbmr.2000.15.6.1001.

    CAS  PubMed  Google Scholar 

  14. van Staa TP, Leufkens HG, Cooper C: The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002, 13: 777-787. 10.1007/s001980200108.

    CAS  PubMed  Google Scholar 

  15. Kanis JA, Johansson H, Oden A, Johnell O, de Laet C, Melton LJ, Tenenhouse A, Reeve J, Silman AJ, Pols HA, Eisman JA, McCloskey EV, Mellstrom D: A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. 2004, 19: 893-899. 10.1359/JBMR.040134.

    PubMed  Google Scholar 

  16. Weinstein RS: Glucocorticoid-induced osteonecrosis. Endocrine. 2012, 41: 183-190. 10.1007/s12020-011-9580-0.

    PubMed Central  CAS  PubMed  Google Scholar 

  17. Kaste SC, Karimova EJ, Neel MD: Osteonecrosis in children after therapy for malignancy. Am J Roentgeno. 2011, 196: 1011-1018. 10.2214/AJR.10.6073.

    Google Scholar 

  18. Barr RD, Sala A: Osteonecrosis in children and adolescents with cancer. Pediatr Blood Cancer. 2008, 50 (2 Suppl): 483-485.

    PubMed  Google Scholar 

  19. Seamon J, Keller T, Saleh J, Cui Q: The pathogenesis of nontraumatic osteonecrosis. Arthritis. 2012, 2012: 601763-

    PubMed Central  PubMed  Google Scholar 

  20. Zhao FC, Li ZR, Guo KJ: Clinical analysis of osteonecrosis of the femoral head induced by steroids. Orthop Surg. 2012, 4: 28-34. 10.1111/j.1757-7861.2011.00163.x.

    PubMed  Google Scholar 

  21. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison’s Principles of Internal Medicine. 2008, The McGraw-Hill Companies, Inc,http://www.amazon.ca/books/dp/0071466339, 17,

    Google Scholar 

  22. Livanou T, Ferriman D, James VH: Recovery of hypothalamo-pituitary-adrenal function after corticosteroid therapy. Lancet. 1967, 2: 856-859.

    CAS  PubMed  Google Scholar 

  23. Henzen C, Suter A, Lerch E, Urbinelli R, Schorno XH, Briner VA: Suppression and recovery of adrenal response after short-term, high-dose glucocorticoid treatment. Lancet. 2000, 355: 542-545. 10.1016/S0140-6736(99)06290-X.

    CAS  PubMed  Google Scholar 

  24. Molimard M, Girodet PO, Pollet C, Fourrier-Réglat A, Daveluy A, Haramburu F, Fayon M, Tabarin A: Inhaled corticosteroids and adrenal insufficiency: prevalence and clinical presentation. Drug Saf. 2008, 31: 769-774. 10.2165/00002018-200831090-00005.

    CAS  PubMed  Google Scholar 

  25. Habib GS: Systemic effects of intra-articular corticosteroids. Clin Rheumatol. 2009, 28: 749-756. 10.1007/s10067-009-1135-x.

    PubMed  Google Scholar 

  26. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ: Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006, 54: 1-15. 10.1016/j.jaad.2005.01.010.

    PubMed  Google Scholar 

  27. Ortega E, Rodriguez C, Strand LJ, Segre E: Effects of cloprednol and other corticosteroids on hypothalamic-pituitary-adrenal axis function. J Int Med Res. 1976, 4: 326-337.

    CAS  PubMed  Google Scholar 

  28. Nichols T, Nugent CA, Tyler FH: Diurnal variation in suppression of adrenal function by glucocorticoids. J Clin Endocrinol Metab. 1965, 25: 343-349. 10.1210/jcem-25-3-343.

    CAS  PubMed  Google Scholar 

  29. Shulman DI, Palmert MR, Kemp SF, Lawson Wilkins Drug and Therapeutics Committee: Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics. 2007, 119: e484-e494. 10.1542/peds.2006-1612.

    PubMed  Google Scholar 

  30. LaRochelle GE, LaRochelle AG, Ratner RE, Borenstein DG: Recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients with rheumatic diseases receiving low-dose prednisone. Am J Med. 1993, 95: 258-264. 10.1016/0002-9343(93)90277-V.

    PubMed  Google Scholar 

  31. Einaudi S, Bertorello N, Masera N, Farinasso L, Barisone E, Rizzari C, Corrias A, Villa A, Riva F, Saracco P, Pastore G: Adrenal axis function after high-dose steroid therapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2008, 50: 537-541. 10.1002/pbc.21339.

    PubMed  Google Scholar 

  32. Curtis JR, Westfall AO, Allison J, Bijlsma JW, Freeman A, George V, Kovac SH, Spettell CM, Saag KG: Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006, 55: 420-426. 10.1002/art.21984.

    PubMed  Google Scholar 

  33. Fardet L, Cabane J, Lebbé C, Morel P, Flahault A: Incidence and risk factors for corticosteroid-induced lipodystrophy: a prospective study. J Am Acad Dermatol. 2007, 57: 604-609. 10.1016/j.jaad.2007.04.018.

    PubMed  Google Scholar 

  34. Huscher D, Thiele K, Gromnica-Ihle E, Gromnica-Ihle E, Hein G, Demary W, Dreher R, Zink A, Buttgereit F: Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis. 2009, 68: 1119-1124. 10.1136/ard.2008.092163.

    CAS  PubMed  Google Scholar 

  35. Schneiter P, Tappy L: Kinetics of dexamethasone-induced alterations of glucose metabolism in healthy humans. Am J Physiol. 1998, 275: E806-E813.

    CAS  PubMed  Google Scholar 

  36. Gurwitz JH, Bohn RL, Glynn RJ, Monane M, Mogun H, Avorn J: Glucocorticoids and the risk for initiation of hypoglycemic therapy. Arch Intern Med. 1994, 154: 97-101. 10.1001/archinte.1994.00420010131015.

    CAS  PubMed  Google Scholar 

  37. Burt MG, Roberts GW, Aguilar-Loza NR, Frith P, Stranks SN: Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD. J Clin Endocrinol Metab. 2011, 96: 1789-1796. 10.1210/jc.2010-2729.

    CAS  PubMed  Google Scholar 

  38. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee: Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2013, 37 (Suppl 1): S1-S212.

    Google Scholar 

  39. American Diabetes Association: Standards of medical care in diabetes — 2012. Diabetes Care. 2012, 35 (Suppl 1): S11-S63.

    Google Scholar 

  40. Black RL, Oglesby RB, von Sallman L, Bunim JJ: Posterior subcapsular cataracts induced by corticosteroids in patients with rheumatoid arthritis. JAMA. 1960, 174: 166-171. 10.1001/jama.1960.63030020005014.

    CAS  PubMed  Google Scholar 

  41. Urban RC, Cotlier E: Corticosteroid-induced cataracts. Surv Ophthalmol. 1986, 31: 102-110. 10.1016/0039-6257(86)90077-9.

    CAS  PubMed  Google Scholar 

  42. Armaly MF: Effect of corticosteroids on intraocular pressure and fluid dynamics: The effect of dexamethasone in the normal eye. Arch Ophthalmol. 1963, 70: 482-491. 10.1001/archopht.1963.00960050484010.

    CAS  PubMed  Google Scholar 

  43. Haimovici R, Gragoudas ES, Duker JS, Sjaarda RN, Eliott D: Central serous chorioretinopathy associated with inhaled or intranasal corticosteroids. Ophthalmol. 1997, 104: 1653-1660. 10.1016/S0161-6420(97)30082-7.

    CAS  Google Scholar 

  44. Schellenberg R, Adachi JDR, Bowie D, Brown J, Guenther L, Kader T, Trope GE: Oral corticosteroids in asthma: a review of benefits and risks. Can Respir J. 2007, 14 (Suppl C): 1C-7C.

    Google Scholar 

  45. Poetker DM, Reh DD: A comprehensive review of the adverse effects of systemic corticosteroids. Otolaryngol Clin North Am. 2010, 43: 753-768. 10.1016/j.otc.2010.04.003.

    PubMed  Google Scholar 

  46. Conn HO, Blitzer BL: Nonassociation of adrenocorticosteroid therapy and peptic ulcer. N Engl J Med. 1976, 294: 434-479.

    Google Scholar 

  47. Conn HO, Poynard T: Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med. 1994, 236: 619-632. 10.1111/j.1365-2796.1994.tb00855.x.

    CAS  PubMed  Google Scholar 

  48. Saag KG, Furst DE: Up To Date 2012. Major side effects of systemic glucocorticoids. 2013,http://www.uptodate.com/contents/major-side-effects-of-systemic-glucocorticoids,

    Google Scholar 

  49. Piper JM, Ray WA, Daugherty JR, Griffin MR: Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991, 114: 735-740. 10.7326/0003-4819-114-9-735.

    CAS  PubMed  Google Scholar 

  50. Messer J, Reitman D, Sacks HS, Smith H, Chalmers TC: Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med. 1983, 309: 21-24. 10.1056/NEJM198307073090105.

    CAS  PubMed  Google Scholar 

  51. Sadr-Azodi O, Mattsson F, Bexlius TS, Lindblad M, Lagergren J, Ljung R: Association of oral glucocorticoid use with an increased risk of acute pancreatitis: a population-based nested case–control study. JAMA Intern Med. 2013, 173: 444-449. 10.1001/jamainternmed.2013.2737.

    CAS  PubMed  Google Scholar 

  52. Derk CT, DeHoratius RJ: Systemic lupus erythematosus and acute pancreatitis: a case series. Clin Rheumatol. 2004, 23: 147-151. 10.1007/s10067-003-0793-3.

    PubMed  Google Scholar 

  53. Wei L, MacDonald TM, Walker BR: Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med. 2004, 141: 764-770. 10.7326/0003-4819-141-10-200411160-00007.

    PubMed  Google Scholar 

  54. Souverein PC, Berard A, Van Staa TP, Cooper C, Egberts AC, Leufkens HG, Walker BR: Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case–control study. Heart. 2004, 90: 859-865. 10.1136/hrt.2003.020180.

    PubMed Central  CAS  PubMed  Google Scholar 

  55. van der Hooft CS, Heeringa J, Brusselle GG, Hofman A, Witteman JC, Kingma JH, Sturkenboom MC, Stricker BH: Corticosteroids and the risk of atrial fibrillation. Arch Intern Med. 2006, 166: 1016-1020. 10.1001/archinte.166.9.1016.

    PubMed  Google Scholar 

  56. Christiansen CF, Christensen S, Mehnert F, Cummings SR, Chapurlat RD, Sørensen HT: Glucocorticoid use and risk of atrial fibrillation or flutter: a population-based, case–control study. Arch Intern Med. 2009, 169: 1677-1683. 10.1001/archinternmed.2009.297.

    PubMed  Google Scholar 

  57. White KP, Driscoll MS, Rothe MJ, Grant-Kels JM: Severe adverse cardiovascular effects of pulse steroid therapy: is continuous cardiac monitoring necessary?. J Am Acad Dermatol. 1994, 30: 768-773. 10.1016/S0190-9622(08)81508-3.

    CAS  PubMed  Google Scholar 

  58. Moghadam-Kia S, Werth VP: Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol. 2010, 49: 239-248. 10.1111/j.1365-4632.2009.04322.x.

    PubMed Central  CAS  PubMed  Google Scholar 

  59. Leong KH, Koh ET, Feng PH, Boey ML: Lipid profiles in patients with systemic lupus erythematosus. J Rheumatol. 1994, 21: 1264-1267.

    CAS  PubMed  Google Scholar 

  60. Petri M, Spence D, Bone LR, Hochberg MC: Coronary artery disease risk factors in the Johns Hopkins Lupus Cohort: prevalence, recognition by patients, and preventive practices. Medicine (Baltimore). 1992, 71: 291-302.

    CAS  Google Scholar 

  61. Svenson KL, Lithell H, Hällgren R, Vessby B: Serum lipoprotein in active rheumatoid arthritis and other chronic inflammatory arthritides. II. Effects of anti-inflammatory and disease-modifying drug treatment. Arch Intern Med. 1987, 147: 1917-1920. 10.1001/archinte.1987.00370110045006.

    CAS  PubMed  Google Scholar 

  62. Choi HK, Seeger JD: Glucocorticoid use and serum lipid levels in US adults: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2005, 53: 528-535. 10.1002/art.21329.

    CAS  PubMed  Google Scholar 

  63. Miller ML: UpToDate 2013. Glucocorticoid-induced myopathy. 2013, [http://www.uptodate.com/contents/glucocorticoid-induced-myopathy?topicKey=RHEUM%2F5171&elapsedTimeMs=3&source=see_link&view=print&displayedView=full]

    Google Scholar 

  64. Bowyer SL, LaMothe MP, Hollister JR: Steroid myopathy: incidence and detection in a population with asthma. J Allergy Clin Immunol. 1985, 76: 234-242. 10.1016/0091-6749(85)90708-0.

    CAS  PubMed  Google Scholar 

  65. LaPier TK: Glucocorticoid-induced muscle atrophy. The role of exercise in treatment and prevention. J Cardiopulm Rehabil. 1997, 17: 76-84. 10.1097/00008483-199703000-00002.

    CAS  PubMed  Google Scholar 

  66. Latronico N, Shehu I, Seghelini E: Neuromuscular sequelae of critical illness. Curr Opin Crit Care. 2005, 11: 381-390. 10.1097/01.ccx.0000168530.30702.3e.

    PubMed  Google Scholar 

  67. Wolkowitz OM, Burke H, Epel ES, Reus VI: Glucocorticoids. Mood, memory, and mechanisms. Ann N Y Acad Sci. 2009, 1179: 19-40. 10.1111/j.1749-6632.2009.04980.x.

    CAS  PubMed  Google Scholar 

  68. Warrington TP, Bostwick JM: Psychiatric adverse effects of corticosteroids. Mayo Clin Proc. 2006, 81: 1361-1367. 10.4065/81.10.1361.

    CAS  PubMed  Google Scholar 

  69. Minden SL, Orav J, Schildkraut JJ: Hypomanic reactions to ACTH and prednisone treatment for multiple sclerosis. Neurology. 1988, 38: 1631-1634. 10.1212/WNL.38.10.1631.

    CAS  PubMed  Google Scholar 

  70. Bolanos SH, Khan DA, Hanczyc M, Bauer MS, Dhanani N, Brown ES: Assessment of mood states in patients receiving long-term corticosteroid therapy and in controls with patient-rated and clinician-rated scales. Ann Allergy Asthma Immunol. 2004, 92: 500-505. 10.1016/S1081-1206(10)61756-5.

    PubMed  Google Scholar 

  71. Swinburn CR, Wakefield JM, Newman SP, Jones PW: Evidence of prednisolone induced mood change (‘steroid euphoria’) in patients with chronic obstructive airways disease. Br J Clin Pharmacol. 1988, 26: 709-713. 10.1111/j.1365-2125.1988.tb05309.x.

    PubMed Central  CAS  PubMed  Google Scholar 

  72. Turner R, Elson E: Sleep disorders. Steroids cause sleep disturbance. BMJ. 1993, 306: 1477-1478.

    PubMed Central  CAS  PubMed  Google Scholar 

  73. Brown ES: Effects of glucocorticoids on mood, memory, and the hippocampus. Treatment and preventive therapy. Ann N Y Acad Sci. 2009, 1179: 41-55. 10.1111/j.1749-6632.2009.04981.x.

    CAS  PubMed  Google Scholar 

  74. Keenan PA, Jacobson MW, Soleymani RM, Mayes MD, Stress ME, Yaldoo DT: The effect on memory of chronic prednisone treatment in patients with systemic disease. Neurology. 1996, 47: 1396-1402. 10.1212/WNL.47.6.1396.

    CAS  PubMed  Google Scholar 

  75. Kershner P, Wang-Cheng R: Psychiatric side effects of steroid therapy. Psychosomatics. 1989, 30: 135-139. 10.1016/S0033-3182(89)72293-3.

    CAS  PubMed  Google Scholar 

  76. Chau SY, Mok CC: Factors predictive of corticosteroid psychosis in patients with systemic lupus erythematosus. Neurology. 2003, 61: 104-107. 10.1212/WNL.61.1.104.

    PubMed  Google Scholar 

  77. Goggans FC, Weisberg LJ, Koran LM: Lithium prophylaxis of prednisone psychosis: a case report. J Clin Psychiatry. 1983, 44: 111-112.

    CAS  PubMed  Google Scholar 

  78. Stuck AE, Minder CE, Frey FJ: Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989, 11: 954-963. 10.1093/clinids/11.6.954.

    CAS  PubMed  Google Scholar 

  79. Saag KG: Short-term and long-term safety of glucocorticoids in rheumatoid arthritis. Bull NYU Hosp Jt Dis. 2012, 70 (Suppl 1): 21-25.

    PubMed  Google Scholar 

  80. Grijalva CG, Chen L, Delzell E, Baddley JW, Beukelman T, Winthrop KL, Griffin MR, Herrinton LJ, Liu L, Ouellet-Hellstrom R, Patkar NM, Solomon DH, Lewis JD, Xie F, Saag KG, Curtis JR: Initiation of tumor necrosis factor-α antagonists and the risk of hospitalization for infection in patients with autoimmune diseases. JAMA. 2011, 306: 2331-2339. 10.1001/jama.2011.1692.

    PubMed Central  CAS  PubMed  Google Scholar 

  81. Allen DB, Mullen M, Mullen B: A meta-analysis of the effect of oral and inhaled corticosteroids on growth. J Allergy Clin Immunol. 1994, 93: 967-976. 10.1016/S0091-6749(94)70043-5.

    CAS  PubMed  Google Scholar 

  82. Allen DB: Growth suppression by glucocorticoid therapy. Endocrinol Metab Clin North Am. 1996, 25: 699-717. 10.1016/S0889-8529(05)70348-0.

    CAS  PubMed  Google Scholar 

  83. Lettgen B, Jeken C, Reiners C: Influence of steroid medication on bone mineral density in children with nephrotic syndrome. Pediatr Nephrol. 1994, 8: 667-670. 10.1007/BF00869084.

    CAS  PubMed  Google Scholar 

  84. Falcini F, Taccetti G, Trapani S, Tafi L, Volpi M: Growth retardation in juvenile chronic arthritis patients treated with steroids. Clin Exp Rheumatol. 1991, 9: 37-40.

    PubMed  Google Scholar 

  85. Markowitz J, Grancher K, Rosa J, Aiges H, Daum F: Growth failure in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 1993, 16: 373-380. 10.1097/00005176-199305000-00005.

    CAS  PubMed  Google Scholar 

  86. Lai HC, FitzSimmons SC, Allen DB, Kosorok MR, Rosenstein BJ, Campbell PW, Farrell PM: Risk of persistent growth impairment after alternate-day prednisone treatment in children with cystic fibrosis. N Engl J Med. 2000, 342: 851-859. 10.1056/NEJM200003233421204.

    CAS  PubMed  Google Scholar 

  87. Miller W, Achermann J, Frankland AW: The adrenal cortex and its disorders. Pediatric Endocrinology. Edited by: Sperling M. 2008, Philadelphia: Saunders, 444-511. 3

    Google Scholar 

  88. Canadian Pediatric Society: Canadian Paediatric Surveillance Program (CPSP): 2010 results. 2010, CPS; PHAC, [http://www.cpsp.cps.ca/uploads/publications/Results-2010.pdf], Accessed March 5, 2013

    Google Scholar 

  89. Canadian Pediatric Society: Canadian Paediatric Surveillance Program (CPSP): 2011 results. 2011, CPS; PHAC, [http://www.cpsp.cps.ca/uploads/publications/Results-2011.pdf], Accessed March 5, 2013

    Google Scholar 

  90. Canadian Pediatric Society: Canadian Paediatric Surveillance Program (CPSP): 2012 results. 2012, CPS; PHAC, [http://www.cpsp.cps.ca/uploads/publications/Results-2012.pdf], Accessed May 14, 2013

    Google Scholar 

  91. Ahmet A, Kim H, Spier S: Adrenal suppression: A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy. Allergy Asthma Clin Immunol. 2011, 7: 13-10.1186/1710-1492-7-13.

    PubMed Central  CAS  PubMed  Google Scholar 

  92. Rix M, Birkebaek NH, Rosthoj S, Clausen N: Clinical impact of corticosteroid-induced adrenal suppression during treatment for acute lymphoblastic leukemia in children: a prospective observational study using the low-dose adrenocorticotropin test. J Pediatr. 2005, 147: 645-650. 10.1016/j.jpeds.2005.06.006.

    CAS  PubMed  Google Scholar 

  93. Gordijn MS, Gemke RJ, van Dalen EC, Rotteveel J, Kaspers GJ: Hypothalamic-pituitary-adrenal (HPA) axis suppression after treatment with glucocorticoid therapy for childhood acute lymphoblastic leukaemia. Cochrane Database Syst Rev. 2012, 5: CD008727

    Google Scholar 

  94. Wood JB, Frankland AW, James VH, Landon J: A rapid test of adrenocortical function. Lancet. 1965, 1: 243-245.

    CAS  PubMed  Google Scholar 

  95. Plager JE, Cushman P: Suppression of the pituitary-ACTH response in man by administration of ACTH or cortisol. J Clin Endocrinol Metab. 1962, 22: 147-154. 10.1210/jcem-22-2-147.

    CAS  PubMed  Google Scholar 

  96. Axelrod L: Glucocorticoid therapy. Medicine (Baltimore). 1976, 55: 39-65. 10.1097/00005792-197601000-00003.

    CAS  Google Scholar 

  97. Amed S, Dean H, Sellers EA, Panagiotopoulos C, Shah BR, Booth GL, Laubscher TA, Dannenbaum D, Hadjiyannakis S, Hamilton JK: Risk factors for medication-induced diabetes and type 2 diabetes. J Pediatr. 2011, 159: 291-296. 10.1016/j.jpeds.2011.01.017.

    PubMed  Google Scholar 

  98. Ho J, Pacaud D: Secondary diabetes in children. Can J Diab. 2004, 28: 400-405.

    Google Scholar 

  99. Stratakis CA: Cushing syndrome in pediatrics. Endocrinol Metab Clin North Am. 2012, 41: 793-803. 10.1016/j.ecl.2012.08.002.

    PubMed Central  PubMed  Google Scholar 

  100. Semeao EJ, Jawad AF, Stouffer NO, Zemel BS, Piccoli DA, Stallings VA: Risk factors for low bone mineral density in children and young adults with Crohn’s disease. J Pediatr. 1999, 135: 593-600. 10.1016/S0022-3476(99)70058-2.

    CAS  PubMed  Google Scholar 

  101. Boot AM, Bouquet J, Krenning EP, de Muinck Keizer-Schrama SMPF: Bone mineral density and nutritional status in children with chronic inflammatory bowel disease. Gut. 1998, 42: 188-194. 10.1136/gut.42.2.188.

    PubMed Central  CAS  PubMed  Google Scholar 

  102. Kotaniemi A, Savolainen A, Kautiainen H, Kröger H: Estimation of central osteopenia in children with chronic polyarthritis treated with glucocorticoids. Pediatrics. 1993, 91: 1127-1130.

    CAS  PubMed  Google Scholar 

  103. Bhudhikanok GS, Wang M-C, Marcus R, Harkins A, Moss RB, Bachrach LK: Bone acquisition and loss in children and adults with cystic fibrosis: a longitudinal study. J Pediatr. 1998, 133: 18-27. 10.1016/S0022-3476(98)70172-6.

    CAS  PubMed  Google Scholar 

  104. Conway SP, Morton AM, Oldroyd B, Truscott JG, White H, Smith AH, Haigh I: Osteoporosis and osteopenia in adults and adolescents with cystic fibrosis: prevalence and associated factors. Thorax. 2000, 55: 798-804. 10.1136/thorax.55.9.798.

    PubMed Central  CAS  PubMed  Google Scholar 

  105. Bardare M, Bianchi ML, Furia M, Gandolini GG, Cohen E, Montesano A: Bone mineral metabolism in juvenile chronic arthritis: the influence of steroids. Clin Exp Rheumatol. 1991, 9 (Suppl 6): 29-31.

    PubMed  Google Scholar 

  106. Fantini F, Beltrametti P, Gallazzi M, Gattinara M, Gerloni V, Murelli M, Parrini M: Evaluation by dual-photon absorptiometry of bone mineral loss in rheumatic children on long-term treatment with corticosteroids. Clin Exp Rheumatol. 1991, 9 (Suppl 6): 21-28.

    PubMed  Google Scholar 

  107. Perez MD, Abrams SA, Loddeke L, Shypailo R, Ellis KJ: Effects of rheumatic disease and corticosteroid treatment on calcium metabolism and bone density in children assessed one year after diagnosis, using stable isotopes and dual energy X-ray absorptiometry. J Rheumatol. 2000, 27 (Suppl 58): 38-43.

    Google Scholar 

  108. van Staa TP, Cooper C, Leufken HGM, Bishop N: Children and the risk of fractures caused by oral corticosteroids. J Bone Miner Res. 2003, 18: 913-918. 10.1359/jbmr.2003.18.5.913.

    CAS  PubMed  Google Scholar 

  109. Halton J, Gaboury I, Grant R, Alos N, Cummings EA, Matzinger M, Shenouda N, Lentle B, Abish S, Atkinson S, Cairney E, Dix D, Israels S, Stephure D, Wilson B, Hay J, Moher D, Rauch F, Siminoski K, Ward LM, Canadian STOPP Consortium: Advanced vertebral fracture among newly diagnosed children with acute lymphoblastic leukemia: results of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) research program. J Bone Miner Res. 2009, 24: 1326-1334. 10.1359/jbmr.090202.

    PubMed Central  PubMed  Google Scholar 

  110. Huber AM, Gaboury I, Cabral DA, Lang B, Ni A, Stephure D, Taback S, Dent P, Ellsworth J, LeBlanc C, Saint-Cyr C, Scuccimarri R, Hay J, Lentle B, Matzinger M, Shenouda N, Moher D, Rauch F, Siminoski K, Ward LM, Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Consortium: Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders. Arthritis Care Res (Hoboken). 2010, 62: 516-526. 10.1002/acr.20171.

    CAS  Google Scholar 

  111. Rodd C, Lang B, Ramsay T, Alos N, Huber AM, Cabral DA, Scuccimarri R, Miettunen PM, Roth J, Atkinson SA, Couch R, Cummings EA, Dent PB, Ellsworth J, Hay J, Houghton K, Jurencak R, Larché M, LeBlanc C, Oen K, Saint-Cyr C, Stein R, Stephure D, Taback S, Lentle B, Matzinger M, Shenouda N, Moher D, Rauch F, Siminoski K, Ward LM, Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Consortium: Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study. Arthritis Care Res (Hoboken). 2012, 64: 122-131. 10.1002/acr.20589.

    Google Scholar 

  112. Feber J, Gaboury I, Ni A, Alos N, Arora S, Bell L, Blydt-Hansen T, Clarson C, Filler G, Hay J, Hebert D, Lentle B, Matzinger M, Midgley J, Moher D, Pinsk M, Rauch F, Rodd C, Shenouda N, Siminoski K, Ward LM, Canadian STOPP Consortium: Skeletal findings in children recently initiating glucocorticoids for the treatment of nephrotic syndrome. Osteoporos Int. 2012, 23: 751-760. 10.1007/s00198-011-1621-2.

    PubMed Central  CAS  PubMed  Google Scholar 

  113. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD, Scientific Advisory Council of Osteoporosis Canada: 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010, 182: 1864-1873. 10.1503/cmaj.100771.

    PubMed Central  PubMed  Google Scholar 

  114. Rodrigues Pereira RM, Carvalho JF, Paula AP, Zerbini C, Domiciano DS, Gonçalves H, Danowski JS, Marques Neto JF, Mendonça LM, Bezerra MC, Terreri MT, Imamura M, Weingrill P, Plapler PG, Radominski S, Tourinho T, Szejnfeld VL, Andrada NC, Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology: Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis. Rev Bras Reumatol. 2012, 52: 580-593. 10.1590/S0482-50042012000400009.

    Google Scholar 

  115. Grossman JM, Gordon R, Ranganath VK, Deal C, Caplan L, Chen W, Curtis JR, Furst DE, McMahon M, Patkar NM, Volkmann E, Saag KG: American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken). 2010, 62: 1515-1526. 10.1002/acr.20295.

    Google Scholar 

  116. National Osteoporosis Guideline Group: Osteoporosis: Clinical guideline for prevention and treatment. Updated July, 2010. 2010, National Osteoporosis Guideline Group, [http://www.shef.ac.uk/NOGG/NOGG_Executive_Summary.pdf], Accessed March 8, 2013

  117. National Osteoporosis Foundation: Clinician’s Guide to Prevention and Treatment of Osteoporosis. 2013, Washington, DC: National Osteoporosis Foundation, [http://www.nof.org/files/nof/public/content/file/917/upload/481.pdf], Accessed March 8, 2013

  118. Kanis JA, Johansson H, Oden A, McCloskey EV: Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011, 22: 809-816. 10.1007/s00198-010-1524-7.

    CAS  PubMed  Google Scholar 

  119. Mushtaq T, Ahmed SF: The impact of corticosteroids on growth and bone health. Arch Dis Child. 2002, 87: 93-96. 10.1136/adc.87.2.93.

    PubMed Central  CAS  PubMed  Google Scholar 

  120. Carella MJ, Srivastava LS, Gossain VV, Rovner DR: Hypothalamic-pituitary-adrenal function one week after a short burst of steroid therapy. J Clin Endocrinol Metab. 1993, 76: 1188-1191. 10.1210/jc.76.5.1188.

    CAS  PubMed  Google Scholar 

  121. Erturk E, Jaffe CA, Barkan AL: Evaluation of the integrity of the hypothalamic-pituitary-adrenal axis by insulin hypoglycemia test. J Clin Endocrinol Metab. 1998, 83: 2350-2354. 10.1210/jc.83.7.2350.

    CAS  PubMed  Google Scholar 

  122. Tordjman K, Jaffe A, Grazas N, Apter C, Stern N: The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary diseases. J Clin Endocrinol Metab. 1995, 80: 1301-1305. 10.1210/jc.80.4.1301.

    CAS  PubMed  Google Scholar 

  123. Tordjman K, Jaffe A, Trostanetsky Y, Greenman Y, Limor R, Stern N: Low-dose (1 microgram) adrenocorticotropin (ACTH) stimulation as a screening test for impaired hypothalamo-pituitary-adrenal axis function: sensitivity, specificity and accuracy in comparison with the high-dose (250 microgram) test. Clin Endocrinol (Oxf). 2000, 52: 633-640. 10.1046/j.1365-2265.2000.00984.x.

    CAS  Google Scholar 

  124. Kazlauskaite R, Evans AT, Villabona CV, Abdu TA, Ambrosi B, Atkinson AB, Choi CH, Clayton RN, Courtney CH, Gonc EN, Maghnie M, Rose SR, Soule SG, Tordjman K, Consortium for Evaluation of Corticotropin Test in Hypothalamic-Pituitary Adrenal Insufficiency: Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency: a meta-analysis. J Clin Endocrinol Metab. 2008, 93: 4245-4253. 10.1210/jc.2008-0710.

    CAS  PubMed  Google Scholar 

  125. Anderson TJ, Grégoire J, Hegele RA, Couture P, Mancini GB, McPherson R, Francis GA, Poirier P, Lau DC, Grover S, Genest J, Carpentier AC, Dufour R, Gupta M, Ward R, Leiter LA, Lonn E, Ng DS, Pearson GJ, Yates GM, Stone JA, Ur E: 2012 update of the Canadian cardiovascular society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013, 29: 151-167. 10.1016/j.cjca.2012.11.032.

    PubMed  Google Scholar 

  126. Davidson J, Wilkinson AH, Dantal J, Dotta F, Haller H, Hernández D, Kasiske BL, Kiberd B, Krentz A, Legendre C, Marchetti P, Markell M, van der Woude FJ, Wheeler DC, International Expert Panel: New-onset diabetes after transplantation: 2003 International Consensus Guidelines. Proceedings of an international expert panel meeting. Barcelona, Spain, 19 February 2003. Transplantation. 2003, 7: SS3-SS24.

    Google Scholar 

  127. Humbert M, Beasley R, Ayres J, Slavin R, Hébert J, Bousquet J, Beeh KM, Ramos S, Canonica GW, Hedgecock S, Fox H, Blogg M, Surrey K: Benefits of omalizumab as add-on therapy in patients with severe persistent asthma who are inadequately controlled despite best available therapy (GINA 2002 step 4 treatment): INNOVATE. Allergy. 2005, 60: 309-316. 10.1111/j.1398-9995.2004.00772.x.

    CAS  PubMed  Google Scholar 

  128. Lougheed MD, Lemiere C, Ducharme FM, Licskai C, Dell SD, Rowe BH, Fitzgerald M, Leigh R, Watson W, Boulet LP, Canadian Thoracic Society Asthma Clinical Assembly: Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults. Can Respir J. 2012, 19: 127-164.

    PubMed Central  PubMed  Google Scholar 

  129. Devogelaer JP, Goemaere S, Boonen S, Body JJ, Kaufman JM, Reginster JY, Rozenberg S, Boutsen Y: Evidence-based guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int. 2006, 17: 8-19. 10.1007/s00198-005-2032-z.

    CAS  PubMed  Google Scholar 

  130. Nawata H, Soen S, Takayanagi R, Tanaka I, Takaoka K, Fukunaga M, Matsumoto T, Suzuki Y, Tanaka H, Fujiwara S, Miki T, Sagawa A, Nishizawa Y, Seino Y, Subcommittee to Study Diagnostic Criteria for Glucocorticoid-Induced Osteoporosis: Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research (2004). J Bone Miner Metab. 2005, 23: 105-109. 10.1007/s00774-004-0596-x.

    PubMed  Google Scholar 

  131. National Osteoporosis Society & Royal College of Physicians Guidelines Working Group for Bone and Tooth Society: Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. 2002, London: Royal College of Physicians

    Google Scholar 

  132. Homik J, Cranney A, Shea B, Tugwell P, Wells G, Adachi R, Suarez-Almazor M: Bisphosphonates for steroid induced osteoporosis. Cochrane Database Syst Rev. 2000, 2: CD001347-

    PubMed  Google Scholar 

  133. Adachi JD, Bensen WG, Brown J, Hanley D, Hodsman A, Josse R, Kendler DL, Lentle B, Olszynski W, Ste-Marie LG, Tenenhouse A, Chines AA: Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med. 1997, 337: 382-387. 10.1056/NEJM199708073370603.

    CAS  PubMed  Google Scholar 

  134. Saag KG, Emkey R, Schnitzer TJ, Brown JP, Hawkins F, Goemaere S, Thamsborg G, Liberman UA, Delmas PD, Malice MP, Czachur M, Daifotis AG: Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med. 1998, 339: 292-299. 10.1056/NEJM199807303390502.

    CAS  PubMed  Google Scholar 

  135. Cohen S, Levy RM, Keller M, Boling E, Emkey RD, Greenwald M, Zizic TM, Wallach S, Sewell KL, Lukert BP, Axelrod DW, Chines AA: Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. 1999, 42: 2309-2318. 10.1002/1529-0131(199911)42:11<2309::AID-ANR8>3.0.CO;2-K.

    CAS  PubMed  Google Scholar 

  136. Wallach S, Cohen S, Reid DM, Hughes RA, Hosking DJ, Laan RF, Doherty SM, Maricic M, Rosen C, Brown J, Barton I, Chines AA: Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int. 2000, 67: 277-285. 10.1007/s002230001146.

    CAS  PubMed  Google Scholar 

  137. Reid DM, Devogelaer JP, Saag K, Roux C, Lau CS, Reginster JY, Papanastasiou P, Ferreira A, Hartl F, Fashola T, Mesenbrink P, Sambrook PN, HORIZON investigators: Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2009, 373: 1253-1263. 10.1016/S0140-6736(09)60250-6.

    CAS  PubMed  Google Scholar 

  138. Roux C, Reid DM, Devogelaer JP, Saag K, Lau CS, Reginster JY, Papanastasiou P, Bucci-Rechtweg C, Su G, Sambrook PN: Post hoc analysis of a single IV infusion of zoledronic acid versus daily oral risedronate on lumbar spine bone mineral density in different subgroups with glucocorticoid-induced osteoporosis. Osteoporos Int. 2012, 23: 1083-1090. 10.1007/s00198-011-1800-1.

    CAS  PubMed  Google Scholar 

  139. Saag KG, Shane E, Boonen S, Marin F, Donley DW, Taylor KA, Dalsky GP, Marcus R: Teriparatide or alendronate in glucocorticoid induced osteoporosis. N Engl J Med. 2007, 357: 2028-2039. 10.1056/NEJMoa071408.

    CAS  PubMed  Google Scholar 

  140. Saag KG, Zanchetta JR, Devogelaer JP, Adler RA, Eastell R, See K, Krege JH, Krohn K, Warner MR: Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six–month results of a randomized, double-blind, controlled trial. Arthritis Rheum. 2009, 60: 3346-3355. 10.1002/art.24879.

    CAS  PubMed  Google Scholar 

  141. Karras D, Stoykov I, Lems WF, Langdahl BL, Ljunggren Ö, Barrett A, Walsh JB, Fahrleitner-Pammer A, Rajzbaum G, Jakob F, Marin F: Effectiveness of teriparatide in postmenopausal women with osteoporosis and glucocorticoid use: 3-year results from the EFOS study. J Rheumatol. 2012, 39: 600-609. 10.3899/jrheum.110947.

    CAS  PubMed  Google Scholar 

  142. Cranney A, Welch V, Adachi JD, Homik J, Shea B, Suarez-Almazor ME, Tugwell P, Wells G: Calcitonin for the treatment and prevention of corticosteroid-induced osteoporosis. Cochrane Database Syst Rev. 2000, 2: CD001983-

    PubMed  Google Scholar 

  143. European Medicines Agency: Calcitonin [bulletin]. 2013, July 2012 [http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Calcitonin/human_referral_000319.jsp&mid=WC0b01ac0580024e99]

    Google Scholar 

  144. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Glüer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR: Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999, 282: 637-645. 10.1001/jama.282.7.637.

    CAS  PubMed  Google Scholar 

  145. Hofbauer LC, Zeitz U, Schoppet M, Skalicky M, Schüler C, Stolina M, Kostenuik PJ, Erben RG: Prevention of glucocorticoid-induced bone loss in mice by inhibition of RANKL. Arthritis Rheum. 2009, 60: 1427-1437. 10.1002/art.24445.

    PubMed  Google Scholar 

  146. Dore RK, Cohen SB, Lane NE, Palmer W, Shergy W, Zhou L, Wang H, Tsuji W, Newmark R, Denosumab RA Study Group: Effects of denosumab on bone mineral density and bone turnover in patients with rheumatoid arthritis receiving concurrent glucocorticoids or bisphosphonates. Ann Rheum Dis. 2010, 69: 872-875. 10.1136/ard.2009.112920.

    CAS  PubMed  Google Scholar 

  147. Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C, FREEDOM Trial: Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009, 361: 756-765. 10.1056/NEJMoa0809493.

    CAS  PubMed  Google Scholar 

  148. Papapoulos S, Chapurlat R, Libanati C, Brandi ML, Brown JP, Czerwiński E, Krieg MA, Man Z, Mellström D, Radominski SC, Reginster JY, Resch H, Román Ivorra JA, Roux C, Vittinghoff E, Austin M, Daizadeh N, Bradley MN, Grauer A, Cummings SR, Bone HG: Five years of denosumab exposure in women with postmenopausal osteoporosis: results from the first two years of the FREEDOM extension. J Bone Miner Res. 2012, 27: 694-701. 10.1002/jbmr.1479.

    PubMed Central  CAS  PubMed  Google Scholar 

  149. Homik J, Suarez-Almazor ME, Shea B, Cranney A, Wells G, Tugwell P: Calcium and vitamin D for corticosteroid-induced osteoporosis. Cochrane Database Syst Rev. 2000, 2: CD000952-

    PubMed  Google Scholar 

  150. Institute of Medicine: Dietary reference intakes for calcium and vitamin D. 2011, Washington, DC: The National Academies Press

    Google Scholar 

  151. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society: Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011, 96: 1911-1930. 10.1210/jc.2011-0385.

    CAS  PubMed  Google Scholar 

  152. Ward L, Tricco AC, Phuong P, Cranney A, Barrowman N, Gaboury I, Rauch F, Tugwell P, Moher D: Bisphosphonate therapy for children and adolescents with secondary osteoporosis. Cochrane Database Syst Rev. 2007, 4: CD005324-

    PubMed  Google Scholar 

  153. Bachrach LK, Ward LM: Clinical review 1: Bisphosphonate use in childhood osteoporosis. J Clin Endocrinol Metab. 2009, 94: 400-409. 10.1210/jc.2008-1531.

    CAS  PubMed  Google Scholar 

  154. Sbrocchi AM, Rauch F, Jacob P, McCormick A, McMillan HJ, Matzinger MA, Ward LM: The use of intravenous bisphosphonate therapy to treat vertebral fractures due to osteoporosis among boys with Duchenne muscular dystrophy. Osteoporos Int. 2012, 23: 2703-2711. 10.1007/s00198-012-1911-3.

    CAS  PubMed  Google Scholar 

  155. Sbrocchi AM, Forget S, Laforte D, Azouz EM, Rodd C: Zoledronic acid for the treatment of osteopenia in pediatric Crohn’s disease. Pediatr Int. 2010, 52: 754-761. 10.1111/j.1442-200X.2010.03174.x.

    CAS  PubMed  Google Scholar 

  156. Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM: The use of alendronate to prevent early collapse of the femoral head in patients with non-traumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am. 2005, 87: 2155-2159. 10.2106/JBJS.D.02959.

    PubMed  Google Scholar 

  157. Agarwala S, Shah SB: Ten year followup of avascular necrosis of femoral head treated with alendronate for 3 years. J Arthroplasty. 2011, 26: 1128-1134. 10.1016/j.arth.2010.11.010.

    PubMed  Google Scholar 

  158. Chen CH, Chang JK, Lai KA, Hou SM, Chang CH, Wang GJ: Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: a two-year multicenter, prospective, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2012, 64: 1572-1578. 10.1002/art.33498.

    CAS  PubMed  Google Scholar 

  159. Kotecha RS, Powers N, Lee SJ, Murray KJ, Carter T, Cole C: Use of bisphosphonates for the treatment of osteonecrosis as a complication of therapy for childhood acute lymphoblastic leukaemia (ALL). Pediatr Blood Cancer. 2010, 54: 934-940.

    PubMed  Google Scholar 

  160. Leblicq C, Laverdière C, Décarie JC, Delisle JF, Isler MH, Moghrabi A, Chabot G, Alos N: Effectiveness of pamidronate as treatment of symptomatic osteonecrosis occurring in children treated for acute lymphoblastic leukemia. Pediatr Blood Cancer. 2013, 60: 741-747. 10.1002/pbc.24313.

    CAS  PubMed  Google Scholar 

  161. Coursin DB, Wood KE: Corticosteroid supplementation for adrenal insufficiency. JAMA. 2002, 287: 236-240. 10.1001/jama.287.2.236.

    CAS  PubMed  Google Scholar 

  162. Salem M, Tainsh RE, Bromberg J, Loriaux DL, Chernow B: Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg. 1994, 219: 416-425. 10.1097/00000658-199404000-00013.

    PubMed Central  CAS  PubMed  Google Scholar 

  163. Ahmed SF, Tucker P, Mushtaq T, Wallace AM, Williams DM, Hughes IA: Short-term effects on linear growth and bone turnover in children randomized to receive prednisolone or dexamethasone. Clin Endocrinol (Oxf). 2002, 57: 185-191. 10.1046/j.1365-2265.2002.01580.x.

    CAS  Google Scholar 

  164. Allen DB, Julius JR, Breen TJ: Treatment of glucocorticoid-induced growth suppression with growth hormone. On behalf of the National Cooperative Growth Study. J Clin Endocrinol Metab. 1998, 83: 2824-2829. 10.1210/jc.83.8.2824.

    CAS  PubMed  Google Scholar 


Page 2

Field of medicine Disorder(s)
Allergy and respirology • Moderate to severe asthma exacerbations
• Acute exacerbations of chronic obstructive pulmonary disease
• Allergic rhinitis
• Atopic dermatitis
• Urticaria/angioedema
• Anaphylaxis
• Food and drug allergies
• Nasal polyps
• Hypersensitivity pneumonitis
• Sarcoidosis
• Acute and chronic eosinophilic pneumonia
• Interstitial lung disease
Dermatology • Pemphigus vulgaris
• Acute, severe contact dermatitis
Endocrinology* • Adrenal insufficiency
• Congenital adrenal hyperplasia
Gastroenterology • Ulcerative colitis
• Crohn’s disease
• Autoimmune hepatitis
Hematology • Lymphoma/leukemia
• Hemolytic anemia
• Idiopathic thrombocytopenic purpura
Rheumatology/immunology • Rheumatoid arthritis
• Systemic lupus erythematosus
• Polymyalgia rheumatica
• Polymyositis/dermatomyositis
• Polyarteritis
• Vasculitis
Ophthalmology • Uveitis
• Keratoconjunctivitis
Other • Multiple sclerosis
• Organ transplantation
• Nephrotic syndrome
• Chronic active hepatitis
• Cerebral edema

  1. NOTE: Systemic corticosteroid uses are not limited to those listed in this table. These agents can be used in almost all areas of medicine.
  2. *In endocrinology, corticosteroid doses are often given at or close to physiologic doses rather than in therapeutic ranges.