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Documented Long-Term Side Effects of Corticosteroids Bone loss and fractures due to calcium and vitamin D depletion and impaired osteoblast activity (2) Blood sugar dysregulation and steroid-induced diabetes through increased insulin resistance and gluconeogenesis (3) Muscle wasting and impaired connective tissue repair from protein catabolism and suppressed synthesis (4) Weakened immunity, delayed healing, and prolonged infections related to micronutrient depletion and immune suppression (5) Weight gain, mood changes, and insomnia driven by hormonal and circadian disruption (6,7) Abnormal blood lipids, hypertension, and increased cardiovascular risk , including heart attack, with long-term use (8) Thinning skin and easy bruising from collagen breakdown and connective tissue loss (9) Psychiatric effects , including anxiety, irritability, depression, andin severe casessteroid-induced psychosis, particularly at higher doses or with prolonged exposure (10) Even short-term corticosteroid use can cause side effects in susceptible patients
Accessed 31 Jan 2021 Arima Y, Chiew M, Matsui T, Emerging Disease Surveillance and Response Team, Division of Health Security and Emergencies, World Health Organization Regional Office for the Western Pacific
Functional milestones Functional improvements often tell you more than pain scores alone: Walking distance without symptom increase Sitting tolerance (minutes before symptoms worsen) Ability to perform previously limited activities Sleep quality (reduced nighttime symptoms indicate improvement) Medication usage (decreasing NSAID use is a positive sign) When to adjust the protocol If there is no improvement after 3 to 4 weeks on a BPC-157 only protocol, consider adding TB-500 for systemic support
The most common complaints are injection-site flushing or warmth, occasional headache, and mild water retention
Korean Journal of Pediatrics
Birnbaum ZW
