Neurological Disorders, Cortocosteroids and fractures, interlinked!!
Written By : Dr. Nandita Mohan
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2022-09-20 03:30 GMT | Update On 2022-09-20 03:30 GMT
Corticosteroids are one of the most frequently used groups of medications, advised by all clinicians across all medical specialties. Specifically, with the advent of "Neuroimmunology" as a branch and recognition of many immune-mediated neurological disorders, the need for steroid use has substantially increased.Corticosteroids are known to cause a reduction in bone mass due to increased...
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Corticosteroids are one of the most frequently used groups of medications, advised by all clinicians across all medical specialties. Specifically, with the advent of "Neuroimmunology" as a branch and recognition of many immune-mediated neurological disorders, the need for steroid use has substantially increased.
Corticosteroids are known to cause a reduction in bone mass due to increased bone resorption and reduced formation. The inhibition of intestinal calcium transport, increased urinary calcium excretion, increase in osteoclastic activity, induction of interleukin–6 receptors in the skeletal cells, decreased level of osteocalcin, alterations in growth/gonadotropin hormones, and complex actions on skeletal cell-gene expression have been implicated.
Patients with neurological disorders have an additional risk of developing bone loss. Interestingly, neurological patients have been poorly represented in trials on preventive treatments for osteoporosis despite their increased risk. Many disorders like various neuromuscular diseases, Parkinson's disease, etc. are associated with an increased risk of falls. Falls are more common as age advances and up to 5% of falls in the geriatric population are known to cause fractures.
Patients with epilepsy not only have an increased risk of falls but are often at higher risk because of exposure to medications like phenytoin, phenobarbital, carbamazepine, valproic acid, etc. While the use of steroids is unavoidable on many occasions, precautions should be advocated to minimize the risk. Patients who require prednisolone at a dose of 7.5 mg or more daily for 6 months or more, should be considered at high risk for the development of early osteoporosis.
About 50 % reduction in fracture rate can be obtained with a judicious and timely treatment adopted. Nonpharmacological therapies like balance and gait training, use of hip protectors, weight-bearing exercises can substantially potentiate the prevention of fractures in these patients. Lifestyle modification with alcohol and smoking cessation should be advised to all patients initiated on corticosteroids.
The ultimate functional status of patients with neurological disorders depends upon multiple factors.
While steroid treatment is a cornerstone for therapy in many immune-mediated neurological diseases, timely prevention of osteoporosis may offer a better disease course with a better quality of life.
Reference: Kapila A, Takkar A. Neurological Disorders, Corticosteroids, and Fracture Risk: Hiding in the Hindsight! J Postgrad Med Edu Res 2022;56(2):61–62.
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