Iranian Journal of Orthopedic Surgery

Abstract Abstract
Corticosteroids are widely used medications with increasing prevalence in clinical practice. In autoimmune and rheumatological diseases, the use of corticosteroids in both pulsed and long-term manners is very common. Due to the COVID-19 pandemic, their consumption increased. However, long-term use is associated with several adverse effects on the musculoskeletal system, including osteoporosis, an elevated risk of fracture, avascular necrosis, hypocalcemia, hypovitaminosis D, and impaired bone growth in children. Corticosteroid-induced osteoporosis is the most common form of secondary osteoporosis. Several factors, such as age, time of use, family history of osteoporosis, previous fractures, and calcium intake, contribute to its prevalence. Corticosteroids exert their effects by disrupting the balance between the activity of osteoblasts and osteoclasts. These medications also disturb the calcium metabolism by altering intestinal calcium absorption and renal calcium excretion. To minimize these side effects, corticosteroid therapy should be limited whenever possible. Also, supplementing with calcium and vitamin D, incorporating breaks of at least three months between corticosteroid courses, and considering alternative therapies, especially in pediatric patients, can help mitigate the potential risks.