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Esteroides orais, osso e cicatrização

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How long-term steroid tablets affect bone, wound healing and surgery, and why they must never be stopped suddenly.

Comprimidos de esteroide ao lado de um osso.
O uso prolongado de comprimidos de esteroides enfraquece os ossos e retarda a cicatrização — e nunca deve ser interrompido abruptamente. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

Se você toma comprimidos de esteroides, esta página é para você. Medicamentos como prednisolona, prednisona ou dexametasona são tratamentos valiosos, às vezes indispensáveis: eles reduzem a inflamação e as respostas imunológicas excessivas, ajudando pessoas com asma, DPOC e uma ampla variedade de doenças inflamatórias e autoimunes a terem uma boa qualidade de vida. Nada do que segue aqui é motivo para interromper o uso desses medicamentos. Contudo, eles têm alguns efeitos que são relevantes na hora da cirurgia; um pouco de planejamento torna tudo mais seguro. A coisa mais útil que você pode fazer é simples: informe à sua equipe que toma esteroides: qual medicamento, qual a dose e há quanto tempo os está tomando.

O que entendemos por “esteroides” aqui

A palavra “esteroide” é usada para designar várias substâncias bem diferentes, por isso é importante esclarecer. Esta página trata dos comprimidos de corticosteroides (prednisolona, prednisona e dexametasona são os mais comuns) tomados regularmente para tratar uma condição médica.

Eles não são a mesma coisa que uma injeção de esteroide em uma articulação ou tendão, que é uma dose local única aplicada para aliviar uma área dolorida (para isso, temos uma página separada sobre injeções de corticosteroides). Também são diferentes dos esteroides anabolizantes, usados para ganho muscular, que às vezes são utilizados no esporte; esses pertencem a uma classe de medicamentos completamente distinta. Quando perguntamos sobre “esteroides” antes da cirurgia, estamos nos referindo aos comprimidos que você toma regularmente.

Esteroides e seus ossos

Um dos efeitos a longo prazo mais importantes dos comprimidos de esteroides é sobre o esqueleto. O uso prolongado de esteroides orais é a causa médica mais comum de osteoporose — um afinamento dos ossos que aumenta a probabilidade de fraturas. Isso é relevante para os cirurgiões, pois ossos mais fortes cicatrizam melhor e mantêm a fixação cirúrgica com mais eficácia; além disso, uma fratura é algo que preferimos evitar a todo custo.

Existem alguns pontos importantes a saber, pois servem tanto para tranquilizar quanto para alertar:

  • O efeito depende da dose e do tempo de uso; porém, mesmo doses diárias moderadas, tomadas durante meses, podem começar a reduzir a resistência óssea.
  • A perda óssea mais rápida ocorre nos primeiros meses após o início do tratamento; por isso, a proteção óssea deve ser considerada o quanto antes.
  • Em geral, esse problema é controlável. A maioria das pessoas que faz uso prolongado de esteroides deve incluir a proteção óssea como parte rotineira de seu tratamento.

Geralmente, isso começa com o básico: ingestão adequada de cálcio e vitamina D. Para pessoas com risco maior, o médico pode prescrever um medicamento para fortalecer os ossos (como um bisfosfonato). Se você faz uso regular de esteroides e ninguém ainda abordou o assunto dos seus ossos, é perfeitamente razoável trazer esse tema à tona. Nossa página sobre saúde óssea e osteoporose aborda esse tema com mais detalhes.

Esteroides, cicatrização de feridas e infecção

Os esteroides atuam atenuando a inflamação e a resposta imunológica, o que precisamente os torna úteis para diversas condições. O lado negativo é que esse mesmo efeito calmante pode fazer com que as feridas cicatrizem um pouco mais devagar e aumentar ligeiramente o risco de infecção. Com o tempo, os esteroides também podem tornar a pele mais fina; por isso, pessoas em tratamento prolongado costumam notar que ficam com hematomas facilmente ou sofrem lacerações cutâneas mesmo com pequenos impactos.

Nada disso significa que a cirurgia não possa ser realizada. Apenas significa que sua equipe médica ficará um pouco mais atenta à ferida, e que é importante ser cuidadoso com a pele ao redor da incisão em processo de cicatrização. Assim como no caso do tabagismo e do álcool (sobre os quais falamos em páginas separadas), qualquer medida que favoreça a cicatrização vale a pena ser adotada nas semanas próximas à operação.

Corticosteroides na época da cirurgia — dois pontos importantes

Este é o aspecto que surpreende muitas pessoas; por isso, vale a pena explicá-lo com clareza.

1. Não interrompa o uso dos corticosteroides de repente. Quando se tomam comprimidos de corticosteroide regularmente, o corpo percebe que há bastante corticosteroide disponível e interrompe sua própria produção. Se os comprimidos forem interrompidos abruptamente, o corpo pode ficar sem nenhuma fonte de corticosteroide por algum tempo, o que pode deixar a pessoa muito doente. Portanto, a menos que um médico oriente o contrário, continue tomando os corticosteroides até e durante a cirurgia.

2. Pode ser necessária uma dose extra de “cobertura” na época da operação. A cirurgia representa um estresse físico; normalmente, o corpo responde produzindo mais corticosteroide próprio. Como os comprimidos de corticosteroide regularmente tomados suprimem essa resposta natural, algumas pessoas precisam de uma dose suplementar de corticosteroide (geralmente administrada por via intravenosa) na época da operação para suprir essa lacuna. Isso é chamado de dose de estresse ou cobertura com corticosteroide, e a equipe cirúrgica e anestésica planeja isso para você; não é preciso fazer nada por conta própria. Trata-se de um procedimento rotineiro e bem estabelecido no cuidado de pacientes que fazem uso prolongado de corticosteroides.

O que isso significa para você — a parte prática

  • Informe à sua equipe que você toma esteroides, e seja específico: qual medicamento, qual dose e há quanto tempo o está tomando. Se você tiver um cartão de esteroides ou uma pulseira de alerta, leve-o consigo.
  • Nunca interrompa ou altere a dose dos seus esteroides por conta própria. Siga as instruções por escrito que lhe foram dadas e pergunte caso algo não esteja claro.
  • Pergunte sobre a saúde dos seus ossos, caso isso ainda não tenha sido abordado: cálcio e vitamina D; às vezes, também é necessário um medicamento para fortalecer os ossos (consulte nossa página sobre saúde óssea).
  • Tenha em mente que esta página trata de comprimidos de esteroides, que são diferentes das injeções de esteroides nas articulações e também diferentes dos esteroides usados para ganho muscular.

Quando procurar ajuda

A maioria das pessoas que tomam esteroides passa pela cirurgia sem problemas. Contudo, vale a pena conhecer os sinais de alerta, pois são fáceis de identificar e agir:

  • Se você esqueceu de tomar as doses de esteroides (por exemplo, devido a vômitos ou doença) e se sente muito cansado ou fraco, tonto ou prestes a desmaiar, ou está vomitando: isso pode ser sinal de deficiência de esteroides no corpo. Procure ajuda médica imediatamente; caso tenha um plano de emergência para esteroides, siga-o.
  • Ao redor da ferida, fique atento a sinais de que ela não está cicatrizando bem ou pode estar infectada: vermelhidão, inchaço, calor ou dor crescentes, secreção ou pus, uma ferida que se abre, ou febre. Informe-nos.
  • E, como sempre: se você não souber como proceder com os esteroides antes da cirurgia, pergunte-nos em vez de tentar adivinhar. Preferimos sempre responder a essa pergunta.

Reviewed by Dr Kieran Hirpara · 24 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

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