The untoward effects of steroid treatment on the musculoskeletal system and what to do about them.

The focus of this review is the musculoskeletal side effects of corticosteroids. These untoward effects can be divided into high-dose phenomena (myopathy and aseptic necrosis) and low-dose problems (growth suppression and osteoporosis). For the clinician, the former group may be an uncommon experience whereas the latter group is highly predictable. The low-dose problems are subtle and asymptomatic, and they can occur in spite of alternate day dosing with steroids. Treatments available to prevent or treat these side effects in patients who are unable to discontinue steroids are reviewed.