Glucocorticoid therapy complications
Dose equivalence, steroid-induced hyperglycaemia and how to dose morning isophane insulin, bone protection and PBS criteria, infection prophylaxis (PJP, strongyloides, hepatitis B, live vaccines), HPA suppression and safe tapering.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- About 1% of adults take long-term oral glucocorticoids, rising to 2 to 3% over 70. Harm depends on dose and duration, but bone loss and hyperglycaemia start within weeks.
- Before a long course, plan for bone, glucose, infection and the HPA axis.
- Fracture risk climbs within 3 months and falls after stopping. Treat at higher BMD than in postmenopausal osteoporosis.
Loading the rest of the note…
Finished reading?
Sources
- European Society of Endocrinology and Endocrine Society joint clinical guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiencyBeuschlein et al., Eur J Endocrinol 2024;190:G25-51 and J Clin Endocrinol Metab 2024, 2024
- 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosisHumphrey et al., Arthritis Rheumatol 2023;75:2088-102, 2022
- Osteoporosis management and fracture prevention in postmenopausal women and men over 50 years of age, 3rd editionAU/NZRACGP and Healthy Bones Australia, 2024
- Endocrinology and Rheumatology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Australian Immunisation Handbook (vaccination for people who are immunocompromised)AU/NZAustralian Technical Advisory Group on Immunisation, Department of Health
- Management of hyperglycaemia and steroid (glucocorticoid) therapyJoint British Diabetes Societies for Inpatient Care, 2023
- Use of oral corticosteroids and risk of fracturesvan Staa et al., J Bone Miner Res 2000;15:993-1000, 2000
- Teriparatide or alendronate in glucocorticoid-induced osteoporosisSaag et al., N Engl J Med 2007;357:2028-39, 2007
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback