NBME 11: Prednisone-induced Osteoperosis

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An old woman who has severe back pain for 2 weeks has been taking 30mg/day prednisone for rheumatoid arthritis for the past 6 months. She's been on estrogen and progesterone replacement therapy for 15 years. Her intake of vitamin D and calcium are adequate but her x-ray shows a vertebral fracture in her spine. What's the most likely reason for the fracture?

-decr Ca absorption --> decr bone formation
-inhibited osteoblast differentiation --> decr bone formation
-decr Ca absorption --> incr bone resorption
-decr serum PTH --> incr bone resorption
-estrogen receptor defect --> incr bone resorption

I feel like there's more than one right answer to this...any takers?

Inhibits osteoblast differentiation, steroids work on the genetic level

If you use this thread http://forums.studentdoctor.net/showthread.php?t=813425, you will find answers on your questions

Haha, actually I'm already using it...I'm only posting questions that don't seem to have a clear consensus on that thread.

I know they can inhibit osteoblastic activity but...can't they also inhibit calcium absorption in the gut?

Originally Posted by MonsterHospital

can't they also inhibit calcium absorption in the gut?

don't think so
as I remember they only decrease RANKL expression on osteoblasts