In patients on long-term low-dose prednisolone (< mg/day or equivalent), calcium and vitamin D 3 therapy may be sufficient to prevent continuing bone loss and reduce falls. However, patients who continue to lose bone or those at high risk of fracture (previous fragility fracture, bone density < -) should also be offered oral bisphosphonates. Although most clinical trial data are limited to 1-2 years, it is rational to maintain fracture prophylaxis for as long as corticosteroids are taken at a daily dose of more than 5 mg prednisolone or equivalent.
Persons who are using drugs that suppress the immune system (., corticosteroids) are more susceptible to infections than healthy individuals. Chickenpox and measles , for example, can have a more serious or even fatal course in susceptible children or adults using corticosteroids. In children or adults who have not had these diseases or been properly immunized, particular care should be taken to avoid exposure. How the dose, route, and duration of corticosteroid administration affect the risk of developing a disseminated infection is not known. The contribution of the underlying disease and/or prior corticosteroid treatment to the risk is also not known. If a patient is exposed to chickenpox, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated. If a patient is exposed to measles, prophylaxis with pooled intramuscular immunoglobulin ( IG ) may be indicated (see the respective package inserts for complete VZIG and IG prescribing information). If chickenpox or measles develops, treatment with antiviral agents may be considered.
Necrosis of hips and joints: A serious complication of long-term use of corticosteroids is aseptic necrosis of the hip joints. Aseptic necrosis is a condition in which there is death and degeneration of the hip bone. It is a painful condition that ultimately can lead to the need for surgical replacement of the hip. Aseptic necrosis also has been reported in the knee joints. The estimated incidence of aseptic necrosis among long-term users of corticosteroids is 3%-4%. Patients taking corticosteroids who develop pain in the hips or knees should report the pain to their doctors promptly.