Your client has been on long term oral steroids to manage end-stage COPD. You know that utilizing steroids for a long period will ________ immunity and potentially cause ________.

Choice A reason: Steroids do not increase immunity; they are potent immunosuppressants. Additionally, while steroids can affect joint health, they are not a primary pharmacological cause of osteoarthritis, which is typically a wear-and-tear degenerative joint disease rather than a direct metabolic side effect of corticosteroid therapy. Choice B reason: While steroids do decrease immunity, they do not typically cause osteoarthritis. This choice is partially correct regarding the immune system but fails to identify the correct skeletal complication associated with the long-term metabolic interference of glucocorticoids on bone mineral density and calcium absorption. Choice C reason: This choice is incorrect because steroids significantly decrease immune function by suppressing the inflammatory response and leukocyte activity. Although it correctly identifies osteoporosis as a potential complication, the first part of the statement contradicts the known pharmacological action of corticosteroid medications. Choice D reason: Long-term glucocorticoid therapy decreases immunity by inhibiting cytokine production and reducing the activity of T-cells and macrophages. Simultaneously, steroids inhibit osteoblast activity and interfere with calcium absorption, leading to a significant reduction in bone mineral density, which results in secondary osteoporosis and increased fracture risk.