Tannirandorn P, Epstein S
Division of Endocrinology, Diabetes and Metabolism, Hospital of theUniversity of Pennsylvania, Philadelphia, USA.
Osteoporos Int. 2000;11(8):637-59. doi: 10.1007/s001980070062.
Bone loss leading to osteoporosis is common after the menopause and in the elderly but uncommon in normal young adults without predisposing factors. The risk factors usually associated with osteoporosis include a family history of osteoporosis or fractures, aging, prior diseases, sedentary lifestyle, low calcium intake, hypogonadism, vitamin D deficiency, smoking, and excessive alcohol consumption. However, the issue of drugs has to be considered in 'normal' individuals who present with osteoporosis or bone loss without predisposing genetic or other environmental factors. The list of drugs is extensive and includes, amongst others, glucocorticoids, thyroid hormone (excess), alcohol, medroxyprogesterone acetate, luteinizing hormone-releasing hormone agonists, anti-seizure medications, cyclosporine A, aluminium, lithium, and exchange resins. This paper reviews the pathophysiology and mechanisms of drug-induced bone loss, which includes osteoporosis and osteomalacia, and treatment concepts. Undoubtedly, physician awareness, appropriate investigation, careful prescribing, monitoring, and proper therapy for this eminently preventable side effect can preserve bone in the patients receiving bone-losing drugs.
绝经后及老年人中，导致骨质疏松的骨质流失很常见，但在无易感因素的正常年轻成年人中并不常见。通常与骨质疏松相关的风险因素包括骨质疏松症或骨折的家族史、衰老、既往疾病、久坐不动的生活方式、钙摄入量低、性腺功能减退、维生素D缺乏、吸烟和过量饮酒。然而，对于那些没有易感遗传或其他环境因素却出现骨质疏松或骨质流失的“正常”个体，必须考虑药物问题。药物种类繁多，其中包括糖皮质激素、甲状腺激素（过量）、酒精、醋酸甲羟孕酮、促黄体生成素释放激素激动剂、抗癫痫药物、环孢素A、铝、锂和离子交换树脂。本文综述了药物性骨质流失（包括骨质疏松症和骨软化症）的病理生理学和机制以及治疗理念。毫无疑问，医生的认知、适当的检查、谨慎的开药、监测以及针对这种完全可预防的副作用的适当治疗，可以保护接受骨质流失药物治疗的患者的骨骼。
