Musculcoskeletal side effects of steroids

Anabolic androgenic steroids (AAS) may cause adverse musculoskeletal effects, especially tendon rupture, attributable both to the disproportionate strength of hypertrophied muscles and to possible deleterious effects of AAS on the architecture of the tendons themselves.

Table 1, sums up the main musculoskeletal adverse effects.

Table 1. Adverse effects in musculoskeletal system. [2]

As suggested by a review article from 1991, the tendon rupture seems to be cause by anatomical distortion, “Anabolic steroid use paralleled with exercise may lead to dysplasia of collagen fibrils, which can decrease the tensile strength of tendon.

Changes in tendon’s crimp morphology have been shown to occur, as well, which may alter the rupturing strain of tendon and the normal biomechanics of the extremities.” [3]

There are multiple cases reported in the medical literature, including bilateral biceps tendon avulsion [4], bilateral rupture of the quadriceps tendon [5], and the list can go on and on.

A study made in rats found that “time-dependent collagen dysplasia and other pathological findings strongly suggest that in mice anabolic steroid treatment predisposes to tendon rupture especially when the animals are exercised.” [6]

An to finish this topic, we’d like to mention that a musculoskeletal adverse effect of particular concern is the premature epiphyseal (growth plates in the children) closure in any child/adolescent, which results in a decrease in adult height after prolonged exposure to androgens, for this reason users under 22 years of age should be aware of the risk of short stature (or shorter than the maximum possible). [7]

Bibliography

1-. Endocr Rev. 2014 Jun; 35(3): 341–375. Published online 2013 Dec 17. doi:  10.1210/er.2013-1058. Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement. Harrison G. Pope, Jr., Ruth I. Wood, Alan Rogol, Fred Nyberg, Larry Bowers, and Shalender Bhasin
(http://www.ncbi.nlm.nih.gov/pubmed/24423981 )
2-. Fundam Clin Pharmacol. 2011 Oct;25(5):535-63. doi: 10.1111/j.1472-8206.2010.00881.x. Epub 2010 Oct 6. Doping and musculoskeletal system: short-term and long-lasting effects of doping agents. Nikolopoulos DD, Spiliopoulou C, Theocharis SE.
(http://www.ncbi.nlm.nih.gov/pubmed/21039821 )
3-. Med Sci Sports Exerc. 1991 Jan;23(1):1-3. Anabolic steroid-induced tendon pathology: a review of the literature. Laseter JT, Russell JA.
(http://www.ncbi.nlm.nih.gov/pubmed/1997802 )
4-.Med Sci Sports Exerc. 1994 Aug;26(8):941-4. Bilateral distal biceps tendon avulsions with use of anabolic steroids. Visuri T, Lindholm H.
(http://www.ncbi.nlm.nih.gov/pubmed/7968426 )
5-. Br J Sports Med. 1995 Jun;29(2):77-9. Bilateral rupture of the quadriceps tendon associated with anabolic steroids. Liow RY, Tavares S.
(http://www.ncbi.nlm.nih.gov/pubmed/7551764 )
6-. Virchows Arch B Cell Pathol Incl Mol Pathol. 1986;52(1):75-86. Organisation of collagen fibrils in tendon: changes induced by an anabolic steroid. I. Functional and ultrastructural studies. Michna H.
(http://www.ncbi.nlm.nih.gov/pubmed/2881396 )
7-. Toxicol Lett. 2005 Sep 15;158(3):167-75. Adverse effects of anabolic steroids in athletes. A constant threat. Maravelias C1, Dona A, Stefanidou M, Spiliopoulou C.
(http://www.ncbi.nlm.nih.gov/pubmed/16005168 )