Biomedical subjects
Publications and source records attributed to A K Bhalla.
The anti-inflammatory and immunosuppressive effects of corticosteroids were first recognized by Hench and colleagues in 1949. It soon became apparent that supraphysiological doses were associated with numerous side effects, particularly osteoporosis and skeletal failure. In spite of this, the pathogenesis of steroid osteoporosis remains unclear and its prevention and treatment controversial.
Osteoporosis is recognised as a common complication of rheumatoid arthritis, with two characteristic patterns--juxta-articular and generalized bone loss. Increasingly sophisticated means of measuring bone turnover and identifying inflammatory mediators which affect bone resorption have enhanced our understanding of the disease process. The aetiology is multifactorial, involving disease-specific and general factors, but the relative importance of the various risks remains uncertain. The evidence for a protective role for oestrogens and the detrimental effect of low dose corticosteroids will be discussed. Biochemical assessment of bone loss lacks sensitivity and specificity, but the rapid improvement in radiological techniques for measuring bone mineral density have improved our ability to diagnose and assess disease progression. The diagnosis and treatment of specific risk factors, such as testosterone or vitamin D deficiency, may be helpful in a few patients, but the ultimate aim must be the early diagnosis and prevention of this potentially catastrophic complication.
The following case report describes a patient who is known to have both fibrous dysplasia and Paget's disease, and traces his history over more than 50 years. The similarities and differences between the two conditions and their relative importance at the various stages of the history are discussed.