How can chronic steroid use negatively affect nutritional status?

• A. It improves calcium absorption
• B. It has no effect on bone metabolism
• C. It increases protein anabolism
• D. It interferes with calcium and vitamin D metabolism and bone formation, potentially leading to osteopenia

Answer: (D)

Chronic glucocorticoid use harms bone health by disrupting calcium and vitamin D metabolism and bone formation. These drugs decrease calcium absorption from the gut, increase calcium loss in the urine, and suppress osteoblast activity while promoting osteoclast activity. They may also impair activation of vitamin D, further reducing calcium availability for bone. Over time, this leads to lower bone mineral density and a higher risk of osteopenia or osteoporosis, which directly impacts nutritional status and fracture risk. In practice, this means ensuring adequate calcium and vitamin D intake and monitoring bone health in patients on long-term steroids, while also recognizing the broader catabolic effects steroids can have on protein and lean mass.