Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, . He is also an FEI veterinarian and works internationally with the United States Equestrian Team. Ball authored Understanding The Equine Eye , Understanding Basic Horse Care , and Understanding Equine First Aid , published by Eclipse Press and available at or by calling 800/582-5604.
If bone density is reduced, the first treatment of choice is bisphosphonates such as cyclical etidronate plus calcium, or alendronate. 9 Hormone replacement therapy (HRT) may also be beneficial in post-menopausal women, 9 however the risks and contraindications of HRT need to be considered. Testosterone therapy may be indicated in men with androgen deficiency. 10 Intervention should also be offered to patients with a past history of fracture after minimal trauma, as this indicates the skeleton is less able to cope with the usual strains of daily living. 10
The adverse effects of corticosteroids in pediatric patients are similar to those in adults (see ADVERSE REACTIONS ). Like adults, pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis. Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity. This negative impact of corticosteroids on growth has been observed at low systemic doses and in the absence of laboratory evidence of HPA axis suppression (., cosyntropen stimulation and basal cortisol plasma levels). Growth velocity may therefore be a more sensitive indicator of systemic corticosteroid exposure in pediatric patients treated with corticosteroids should be monitored, and the potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the availability of treatment alternatives. In order to minimize the potential growth effects of corticosteroids, pediatric patients should be titrated to the lowest effective dose.