This is a known fact to many yet some are unaware of the adverse effects of long term use of steroids. While it is the opted therapy for most of the diseases at severe stages, it should never be given as a mono-therapy in case of long term treatment, and self-medication is not recommended as it leads to dependency and can result fatal overtime.
The major adverse effect is suppression of immune system and progressive loss of bone, medically termed as Osteoporosis, where the bones become brittle in nature. Steroids are known to enhance the activity of osteoclasts involved in re-absorption of calcium from bones and suppress the activity of osteoblast which helps in bone formation, resulting in an imbalance between these cells and gradually leads to loss of bone strength.
Another major adverse effect is metabolic syndrome where blood glucose levels and lipid profile are altered in some while signs and symptoms may vary in different individuals. This is may be usually misdiagnosed as Cushing syndrome due to similar signs and symptoms. The reports of blood glucose levels may indicate high fasting blood glucose and low post-prandial blood glucose in some cases due to development of insulin resistance syndrome, may be misdiagnosed as Diabetes Mellitus. Proper assessment of past medical history and medications is recommended before initiating any therapy.
For prevention of Osteoporosis, standard guidelines suggest the use of osteoclast suppressors/osteoblast promoters/bisphosphonates as adjunct with steroid therapy in cases where it has to be continued for lifetime. And in case where altered blood glucose levels are observed in-spite of treatment, further assessment of the case should be considered.