The question of whether steroids can cause bone cancer is often prompted by public confusion over the term “steroid” and concerns about their health effects. Steroids are a large class of compounds, and their impact on the body, including cancer risk, varies dramatically based on their specific type and use. This article aims to provide clarity on the evidence-based link between the two main classes of steroids—those used for performance enhancement and those used medically—and the development of primary bone cancer. Understanding the distinct differences between these compounds is the first step in accurately assessing the potential risks to skeletal health.
Defining the Two Classes of Steroids
The term “steroids” broadly refers to compounds with a specific chemical structure, but in a health context, it generally separates into two major categories with opposing functions. The first category is Anabolic-Androgenic Steroids (AAS), which are synthetic derivatives of the male sex hormone testosterone. They are primarily known for their anabolic effect of promoting skeletal muscle growth and their androgenic effect of developing male characteristics, often being misused for performance and physique enhancement.
The second major class is Corticosteroids, which are drugs like prednisone, hydrocortisone, and dexamethasone, that mimic the action of the stress hormone cortisol. These are prescribed by doctors to reduce inflammation and suppress the immune system, treating conditions like asthma, allergies, and autoimmune disorders. Corticosteroids work by binding to glucocorticoid receptors, whereas anabolic steroids bind to androgen receptors, resulting in very different effects on the body’s tissues.
Direct Link to Bone Cancer: What the Research Shows
Current scientific literature and large-scale epidemiological studies do not establish a direct, causal link between either anabolic steroids or corticosteroids and the development of primary bone cancers, such as osteosarcoma. This type of cancer is rare, and the available data does not suggest that steroid use increases its incidence in humans. The confusion often stems from the known association between anabolic steroids and other types of cancer, particularly in the liver.
Anabolic-androgenic steroids, especially when abused at high doses or for long durations, have been linked to the development of liver tumors, including hepatocellular adenomas and carcinomas. This connection is well-documented in clinical case reports, yet the evidence for malignant tumor development originating in the bone tissue remains inconclusive or absent. Some anabolic agents used to treat osteoporosis, which are sometimes confused with AAS, have even been found in studies not to be associated with an increased risk of primary bone malignancy.
For corticosteroids, which are often used in cancer treatment protocols to manage symptoms like brain swelling, there is also no clear evidence suggesting they cause primary bone cancer. While some studies mention a potential increased risk for a rare type of cancer called Kaposi’s sarcoma with corticosteroid use, this is a cancer of the blood vessel walls and not a primary bone malignancy. The prevailing scientific conclusion is that neither steroid class has a direct role in initiating the malignant transformation of bone cells.
Established Risks to Bone Health and Cancer Development
Although a direct link to primary bone cancer is not supported by evidence, both classes of steroids carry established risks that affect the skeleton or involve cancer development elsewhere in the body. Corticosteroids, particularly when used long-term or at high doses, are a leading cause of drug-induced bone loss. These medications disrupt the balance of bone remodeling by suppressing the activity of bone-building cells (osteoblasts) and increasing the lifespan of bone-resorbing cells (osteoclasts).
This mechanism leads to a rapid loss of bone mineral density, significantly increasing the risk of osteoporosis and subsequent fractures, especially in the ribs and vertebrae. The risk of fracture can increase by over 50% in the first year for patients prescribed a daily dose of 7.5mg or more of prednisolone. Long-term corticosteroid exposure is also a known risk factor for avascular necrosis, or osteonecrosis, a condition where bone tissue dies due to a lack of blood supply.
Anabolic steroids, while not linked to primary bone cancer, are strongly associated with other cancer risks, most notably liver tumors, with case reports pointing to a causal connection between high-dose abuse and hepatocellular carcinoma. In adolescents, the abuse of anabolic steroids can also prematurely close the growth plates, resulting in stunted growth and a permanent reduction in adult height. Moreover, unregulated anabolic steroids purchased outside medical channels have been found to contain heavy metal contaminants like lead and arsenic, substances that are recognized for their cancer-causing properties, introducing an additional risk of malignancy.