Isidro McLean
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About
Taking Anabolic Steroids After A Sport Injury
Anabolic steroids (often called "anabolic‑androgenic steroids" or AAS) are synthetic derivatives of testosterone that possess both anabolic (muscle‑building) and androgenic (male‑characteristic) properties. The most common examples in medical practice are testosterone, nandrolone decanoate (Deca‑Durabolin), oxymetholone, stanozolol, and a few others that are used in very specific clinical settings.
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1. Clinical uses of anabolic steroids
Indication Typical agent & dosing Goal
Muscle wasting (cachexia, AIDS‑related wasting) Testosterone enanthate 100–200 mg IM q2–3 wks Restore lean body mass, improve appetite
Hypogonadism Testosterone cypionate/enanthate 50–200 mg IM q1–2 wks or transdermal gels (30–60 g/day) Replace endogenous testosterone, maintain normal libido, bone density
Anemia of chronic disease Low‑dose oral testosterone 0.5 mg daily for months Increase erythropoiesis (rarely used)
Idiopathic thrombocytopenic purpura (ITP) Oral methylprednisolone + low‑dose testosterone (e.g., 2 mg BID) Stimulate megakaryocyte proliferation (experimental)
Idiopathic neutropenia Low‑dose oral steroids + recombinant GCSF (G-CSF) Increase neutrophil count
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3. Practical Tips for Using Steroids in Common Clinical Situations
A. Treating Infections
Infection Typical Regimen Key Points
Bacterial pneumonia Oral prednisone 0.5 mg/kg/day (max 40 mg) for 5–7 days, then taper over 3‑4 weeks. Use if severe inflammatory response; monitor CBC & glucose.
Severe viral infections (e.g., COVID‑19) Dexamethasone 6 mg IV/PO daily for 10 days or until discharge. Proven mortality benefit in patients requiring oxygen or ventilation.
Always start antibiotics before steroids unless contraindicated.
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4. Monitoring & Managing Side Effects
Parameter Frequency Action
Blood pressure Daily (or with each dose) If >140/90 mmHg, consider antihypertensives; adjust steroid dose if needed.
Glucose Fast‑blood glucose daily (morning & bedtime) Start metformin or insulin if >180 mg/dL on two consecutive readings.
Weight / BMI Every visit If weight gain >5% of baseline, reassess diet and exercise plan; consider reducing steroid dose.
Mood/Behavior Weekly (or as needed) Monitor for anxiety, irritability; provide counseling or psychiatric referral if severe.
Bone Health Baseline DEXA at 1 year; repeat at 3 years If T-score ≤ –2.5, start calcium 1000 mg + vitamin D 800 IU daily and bisphosphonate therapy (e.g., alendronate 70 mg weekly).
Infection Signs Continuous monitoring Educate parents on red flags: fever, persistent cough; prompt medical evaluation.
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7. Education & Support for Family
Lifestyle Counseling
Encourage regular physical activity (e.g., sports, playtime) and balanced diet rich in calcium/vitamin D.
Discuss weight‑bearing exercises that help bone strength.
Medication Adherence Plan
Use pill organizers or smartphone reminders for oral meds.
Keep a medication diary noting dates/times; bring to each visit.
Emergency Preparedness
Carry an updated medical card listing diagnosis, medications, allergies, and emergency contacts.
Know when to seek urgent care (e.g., severe pain, swelling, fever).
Support Resources
Connect with local or online support groups for families dealing with bone disorders.
Provide educational materials from reputable sources (American College of Rheumatology, National Osteoporosis Foundation).
Lifestyle Guidance
Encourage balanced diet rich in calcium and vitamin D; discuss supplementation if needed.
Promote safe physical activity: weight‑bearing exercises for bone strength, flexibility routines to reduce injury risk.
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8. Summary
Primary Diagnosis: Osteogenesis Imperfecta (type IV) – brittle bones with frequent fractures.
Secondary Diagnosis: Scoliosis (curvature of the spine).
Differential Diagnoses: OI type V, osteopetrosis, hyperparathyroidism, rickets/osteomalacia, metabolic bone disease.
Diagnostic Tests: Radiographs, DXA scan, laboratory studies (serum calcium/phosphate/PTH), genetic testing for COL1A1/COL1A2 mutations, skeletal survey, spinal imaging.
Management Plan: Multidisciplinary approach including orthopedic care, physiotherapy, pharmacologic treatment (bisphosphonates), pain control, scoliosis monitoring and management, nutritional support, psychosocial counseling.
Differential Diagnosis with OI Type V:
Feature OI Type IV OI Type V
Bone fragility Severe Moderate
Skeletal deformities Extensive (wrist/hand) Fewer, primarily tibial
Radiographic findings Looser lines, bone marrow edema Radiolucent diaphyseal bands; pseudoarthrosis
Growth Short stature Normal to short
Dental abnormalities Mild Severe hypodontia, enamel defects
Family history Autosomal dominant Autosomal dominant
Inheritance AD AD
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4. Management and Treatment Plan
A. Immediate Care (First 24–48 h)
Pain control – Paracetamol or ibuprofen; consider opioids if severe.
Stabilization of fractures – Soft splint for humeral fracture; immobilize wrist to prevent further injury.
Monitoring – Observe vital signs, neurologic status, and limb perfusion.
B. Short‑Term Management (Days 1–14)
Component Actions
Physical therapy Initiate gentle range‑of‑motion exercises for the wrist once pain allows; maintain upper‑arm splinting to support healing.
Bone health Continue calcium and vitamin D supplementation. If not already started, begin a low‑dose bisphosphonate (e.g., alendronate 70 mg weekly) to reduce bone turnover.
Pain control Use acetaminophen or NSAIDs as needed; avoid excessive dosing.
C. Long‑Term Management (Months 3–12+)
Bone density monitoring
Repeat DXA scan at 12 months to assess response to bisphosphonate therapy and detect any further declines.
Lifestyle optimization
Encourage a diet rich in calcium (≈ 1000 mg/day) and vitamin D (600–800 IU/day).
Recommend safe weight‑bearing exercise, such as brisk walking or low‑impact aerobics.
Medication review
Evaluate the necessity of continuing bisphosphonate therapy; many clinicians maintain treatment for 5 years in patients at high risk.
Consider adjunctive agents (e.g., denosumab) if bone density does not improve.
Fall prevention
Home safety assessment to reduce fall risks.
Balance training or physiotherapy if indicated.
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3. Rationale for the Proposed Plan
Early Identification of Osteoporosis – The 30% decrease in DXA Z‑score is a strong predictor of future fractures, especially hip and vertebral fractures, which carry high morbidity and mortality.
Preventing Fractures – Pharmacologic treatment with bisphosphonates reduces the risk of new fractures by up to 50–70%. Early initiation after a low BMD result maximizes benefit.
Monitoring and Safety – Regular follow‑up ensures adherence, detects side effects (e.g., GI upset, osteonecrosis of jaw), and evaluates treatment efficacy via repeated DXA scans.
Comprehensive Care – Addressing lifestyle factors and secondary causes creates a holistic approach that enhances bone health beyond pharmacotherapy alone.
Health System Alignment – The plan aligns with best practice guidelines (e.g., WHO, NICE) and supports preventive care models that reduce future fracture burden and associated healthcare costs.
4. Implementation Timeline
Month Action
0-1 Complete baseline assessment; prescribe first‑line therapy; initiate lifestyle counseling.
3 Reassess vitamin D status; adjust supplements if needed.
6 25(OH)D repeat test; evaluate adherence and side effects.
12 DXA scan; review treatment plan; consider transition to bisphosphonate if indicated.
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5. Monitoring & Evaluation
Clinical Outcomes: Incidence of new fractures, bone pain resolution.
Biomarkers: Vitamin D levels, calcium homeostasis.
Patient‑Reported Measures: Quality of life, adherence scores.
Data will be reviewed annually to refine protocols and ensure best practice standards are maintained.
Prepared by:
Your Name, MD – Endocrinology & Metabolism
Institution / Department
Approved by: Name, Chair, Clinical Committee
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End of Report*
