What is the main concern with long-term steroid therapy?

Long-term steroid therapy is primarily associated with the risk of hyperglycemia. Corticosteroids, such as prednisone, can increase blood sugar levels by stimulating gluconeogenesis in the liver and decreasing insulin sensitivity in muscle and adipose tissues. This effect can lead to elevated glucose levels in the blood, which can be particularly concerning for individuals who may already have conditions such as diabetes or those at risk of developing diabetes.

In terms of the context for the other options, hypoglycemia is less commonly associated with steroid use, as steroids typically raise blood sugar levels rather than lower them. Improved muscle strength and enhanced wound healing are often seen as benefits of short-term steroid use in specific conditions; however, with chronic use, the opposite may occur due to steroid-induced muscle wasting and slowed tissue repair. Therefore, the main concern with long-term use of steroids lies significantly in the management of hyperglycemia and its related complications.