Selenium deficiency is a well‑established cause of dilated cardiomyopathy and heart failure in low‑selenium regions, classically described as Keshan disease. In these endemic low‑selenium areas, large supplementation trials with sodium selenite significantly reduced the incidence of Keshan disease, providing strong evidence that inadequate selenium intake is a major causal factor rather than a mere association. Modern case reports in patients on long‑term parenteral nutrition, after bariatric surgery, or on highly restrictive elemental diets describe severe, sometimes rapidly progressive heart failure that improves with selenium repletion, underscoring that selenium‑deficiency cardiomyopathy remains a relevant, treatable diagnosis in contemporary clinical practice. This medication is commonly used for Inflammation.
Yusuf SW, Rehman Q, Casscells W. Cardiomyopathy in association with selenium deficiency: a case report. JPEN J Parenter Enteral Nutr. 2002 Jan-Feb;26(1):63-6. Chen X, Yang G, Chen J, Chen X, Wen Z, Ge K. Studies on the relations of selenium and Keshan disease. Biol Trace Elem Res. 1980 Jun;2(2):91-107. Munguti CM, Al Rifai M, Shaheen W. A Rare Cause of Cardiomyopathy: A Case of Selenium Deficiency Causing Severe Cardiomyopathy thFujita Y, Chida-Nagai A, Shibukawa N, Tatsunori I, Suzuki Y, Sasaki D, Yamazawa H, Takeda A. Secondary Cardiomyopathy Due to Selenium Deficiency: Multidimensional Cardiac Evaluation and Treatment. JACC Case Rep. 2025 Aug 20;30(24):104665.at Improved on Supplementation. Cureus. 2017 Aug 29;9(8):e1627.
Some side effects may be linked to nutrient depletion caused by this medication.
Research suggests corticosteroids can lower vitamin D levels in the body by increasing its breakdown. This is a concern because vitamin D plays a crucial role in bone health and the immune system, and corticosteroids themselves can weaken bones. A study found that calcium and vitamin D3 supplements helped prevent bone loss in the lower back (lumbar spine) and hip (trochanter) for people with rheumatoid arthritis who were on low-dose corticosteroids. Evidence suggests vitamin D may work synergistically together with corticosteroids to improve asthma treatment by boosting the effectiveness of corticosteroids or by overcoming resistance to these medications in some patients.
Corticosteroids can lower calcium levels in the body. This is a double threat to bone health because corticosteroids themselves can weaken bones. Calcium is essential for strong bones, and a study showed that supplementing with both calcium and vitamin D3 helped prevent bone loss in people with rheumatoid arthritis taking corticosteroids. Supplementation with calcium should be considered during long term corticosteroid therapy.
Corticosteroids can increase the urinary loss of selenium elevating the risk for deficient levels. Selenium is a mineral that acts as an antioxidant, helping protect cells from damage. Studies have shown that rheumatoid arthritis patients taking high doses of corticosteroids tend to have lower selenium levels. This is concerning because low selenium intake is linked to osteoporosis, and selenium has been shown to play a role in bone protection in animal models of corticosteroid-induced osteoporosis. Supplementation with selenium should be considered during long term corticosteroid therapy.