Prevention of glucocorticoid-induced osteoporosis in immunobullous diseases with alendronate: A randomized, double-blind, placebo-controlled study. Divittorio G, Jackson KL, Chindalore VL, Welker W, Walker JB. Steroids and risk of upper gastrointestinal complications.

Lehman JS, Kalaaji AN. …mg of prednisone daily (for dexamethasone, approximately 3 mg daily or more) should receive PCP prophylaxis with trimethoprim-sulfamethoxazole or an acceptable alternative regimen … 2005;92(5):867-872. 2001;153(11):1089-1093. The mean dose at time of diagnosis was prednisone 37mg with mean duration of 10 weeks. Cote GA, Howden CW. Gonnelli S, Rottoli P, Cepollaro C, et al.

N Engl J Med. 12. 11. It is clear that corticosteroids in conjunction with NSAIDs is a major risk factor for PUD and should be avoided; when unavoidable, patients would likely benefit from acid suppressive therapy. J Rheumatol. The patient is started on prednisone 40mg with the plan to decrease the dose after remission of symptoms, which may take a number of months. 1976;294(9):473-479. 14. 18. 29. Am J Epidemiol.

24. 6. A randomized, placebo-controlled trial of calcium supplementation for decreased bone density in corticosteroid-using patients with inflammatory bowel disease: A pilot study. One of the first studies randomized 477 patients receiving corticosteroids (average prednisone dose of 9-10mg/day) with diagnoses across specialties over Different specialty groups have individually confirmed this benefit of bisphosphonates.

Mayo Clin Proc. Liu RH, Albrecht J, Werth VP. Dose-related patterns of glucocorticoid-induced side effects. 31. Conn HO, Blitzer BL. Worth LJ, Dooley MJ, Seymour JF, Mileshkin L, Slavin MA, Thursky KA. Br J Cancer. Grossman JM, Gordon R, Ranganath VK, et al. 3. 4. Preventive effect of sulfamethoxasole-trimethoprim on pneumocystis jiroveci pneumonia in patients with interstitial pneumonia. Association of adrenocorticosteroid therapy and peptic-ulcer disease. An analysis of the utilisation of chemoprophylaxis against pneumocystis jirovecii pneumonia in patients with malignancy receiving corticosteroid therapy at a cancer hospital.

Arch Dermatol. Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. A retrospective study of 116 PCP patients without AIDS were analyzed and compared by underlying disease process including hematologic malignancy, solid tumors, organ transplants, inflammatory diseases, and other.

Ann Rheum Dis. I. 1996;71(1):5-13. Wall E, Walker-Bone K. Use of bisphosphonates and dual-energy x-ray absorptiometry scans in the prevention and treatment of glucocorticoid-induced osteoporosis in rheumatology.

Inappropriate prescription of PPIs in the setting of steroid use 2010;45(10):1156-1161. 8. Although the first-line agent trimethoprim-sulfamethaxoazole (TMP-SMX) is very effective at preventing PCP, it comes with its own consequences including adverse drug reactions, cost, and risk of antibiotic resistance.As before, the risk of PCP is correlated with dose and duration of corticosteroid use, but with PCP there is the added variable of the relative immune dysregulation caused by the underlying disease being treated.

21. 1996;71(1):102-103. 2006;355(7):675-684. Examining the relationship between bone mineral density and fracture risk reduction during pharmacologic treatment of osteoporosis. American college of rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. In rheumatology, a study of 200 patients with rheumatic diseases compared alendronate 10mg to alfacalcidol over 18 months and found an increase in BMD by +2.1% in bisphosphonate groupMoving on to PUD, there is a theoretical benefit of reducing gastric pH with agents such as proton-pump inhibitors (PPIs) to prevent steroid-induced peptic ulcers. Clin Infect Dis. Lambrinoudaki I, Chan DT, Lau CS, Wong RW, Yeung SS, Kung AW. 2. 15. Clinical trial: Comparison of alendronate and alfacalcidol in glucocorticoid-associated osteoporosis in patients with ulcerative colitis. Role of primary prophylaxis for pneumocystis pneumonia in patients treated with systemic corticosteroids or other immunosuppressive agents for immune-mediated dermatologic conditions. A study of 360 physicians in the Czech Republic (100 from Gastroenterology, 100 from General Practice, 80 from Pulmonology/Immunology, and 80 from Neurology/Neurosurgery) found that 82% of physicians (61% of gastroenterologists) believed that corticosteroids significantly increase the risk of PUD and 75% of physicians (55% of gastroenterologists) believed that gastroprotective therapy was appropriate for patients on 1.

Hernandez-Diaz S, Rodriguez LA. Z Rheumatol. A 55 year-old male is recently diagnosed with systemic sarcoidosis. Effect of corticotropin (acth) and cortisone on gastric secretion. However, there is limited data on the subject largely because, despite much notoriety, there is limited data to even show that corticosteroids actually cause peptic ulcers in the first place.