Soucy E, Bellamy N, Adachi J D, Pope J E, Flynn J, Sutton E, Campbell J
Department of Medicine, University of Western Ontario, London, Canada.
J Rheumatol. 2000 Jun;27(6):1506-12.
To survey the practice pattern of Canadian rheumatologists (CR) on their management of corticosteroid induced osteoporosis in their premenopausal (PrM) and postmenopausal (PoM) female patients.
The practice pattern was surveyed using a 17 item questionnaire probing the diagnosis, prevention, treatment, and monitoring of osteoporosis in PrM and PoM women receiving longterm oral systemic corticosteroid therapy.
Most CR investigated and treated osteoporosis themselves, 13% referred to other specialists for investigation, and 22% referred for treatment. Eighty-two percent of CR used dual energy x-ray absorptiometry (DEXA) to confirm a diagnosis of osteoporosis. Most CR initiated investigation for osteoporosis at the start or within the first year of starting longterm systemic corticosteroid therapy: PrM 87% and PoM 93%. The most frequently used initial strategy for the prevention of osteoporosis was as follows. PrM: calcium and vitamin D3 (53%); PoM: hormone replacement therapy (HRT) and calcium (29%). The most common initial choice for treatment of established osteoporosis was as follows: PrM: etidronate (53%); PoM: bisphosphonates +/- HRT (53%). Ninety-six percent of CR used only bone mineral density (BMD) measurement to monitor therapy for corticosteroid induced osteoporosis. Most CR monitored BMD every 12 to 24 months for PrM (81%) and PoM (84%). The BMD parameter(s) (T and Z scores as measured by DEXA) used to initiate therapy for corticosteroid induced osteoporosis was variable.
It appears that, while certain trends are evident, there is still considerable variability in the management of corticosteroid induced osteoporosis.
调查加拿大风湿病学家（CR）对绝经前（PrM）和绝经后（PoM）女性患者糖皮质激素诱导性骨质疏松症的管理实践模式。
使用一份包含17项问题的问卷对实践模式进行调查，该问卷涉及接受长期口服全身糖皮质激素治疗的PrM和PoM女性骨质疏松症的诊断、预防、治疗及监测。
大多数CR自行调查和治疗骨质疏松症，13%会将患者转介给其他专科医生进行调查，22%会转介进行治疗。82%的CR使用双能X线吸收法（DEXA）来确诊骨质疏松症。大多数CR在开始长期全身糖皮质激素治疗时或第一年内就开始对骨质疏松症进行调查：PrM为87%，PoM为93%。预防骨质疏松症最常用的初始策略如下。PrM：钙和维生素D3（53%）；PoM：激素替代疗法（HRT）和钙（29%）。已确诊骨质疏松症治疗的最常见初始选择如下：PrM：依替膦酸（53%）；PoM：双膦酸盐+/-HRT（53%）。96%的CR仅使用骨密度（BMD）测量来监测糖皮质激素诱导性骨质疏松症的治疗。大多数CR对PrM（81%）和PoM（84%）每12至24个月监测一次BMD。用于启动糖皮质激素诱导性骨质疏松症治疗的BMD参数（通过DEXA测量的T值和Z值）各不相同。
虽然某些趋势明显，但糖皮质激素诱导性骨质疏松症的管理仍存在相当大的差异。
