Sambrook P, Lane N E
Institute of Bone and Joint Research, University of Sydney, Sydney, Australia.
Best Pract Res Clin Rheumatol. 2001 Jul;15(3):401-13. doi: 10.1053/berh.2001.0157.
Corticosteroids are widely used and effective agents for the control of many inflammatory diseases, but corticosteroid osteoporosis is a common problem associated with their long term high dose use. Prevention of corticosteroid osteoporosis is preferable to treatment of established corticosteroid bone loss. Several large double-blind controlled clinical trials in patients with corticosteroid osteoporosis have recently been published that provide new insights into its treatment. Based upon available evidence, the rank order of choice for prophylaxis would be a bisphosphonate followed by a vitamin D metabolite or an oestrogen type medication. Calcium alone appears to be unable to prevent rapid bone loss in patients starting corticosteroids, especially with prednisolone doses at 10 mg a day or greater. If an active vitamin D metabolite is used, calcium supplementation should be avoided unless dietary calcium intake is low. Hormone replacement therapy should be considered if hypogonadism is present. Since vertebral fracture is a common and important complication of high dose corticosteroid therapy, these findings suggest that rapid bone loss and hence fractures, can be prevented by prophylactic treatment. Although the follow-up data is limited, it is likely that such therapy needs to be continued beyond 12 months whilst patients continue significant doses of corticosteroid therapy.
皮质类固醇是广泛应用且有效的控制多种炎症性疾病的药物，但皮质类固醇性骨质疏松是与其长期高剂量使用相关的常见问题。预防皮质类固醇性骨质疏松优于治疗已发生的皮质类固醇性骨质流失。最近发表了几项针对皮质类固醇性骨质疏松患者的大型双盲对照临床试验，为其治疗提供了新的见解。根据现有证据，预防用药的首选顺序是双膦酸盐，其次是维生素D代谢物或雌激素类药物。单独使用钙似乎无法预防开始使用皮质类固醇的患者出现快速骨质流失，尤其是当泼尼松龙剂量达到每日10毫克或更高时。如果使用活性维生素D代谢物，除非饮食中钙摄入量低，否则应避免补充钙。如果存在性腺功能减退，应考虑激素替代疗法。由于椎体骨折是高剂量皮质类固醇治疗常见且重要的并发症，这些发现表明预防性治疗可预防快速骨质流失及由此导致的骨折。尽管随访数据有限，但很可能在患者持续使用大剂量皮质类固醇治疗期间，此类治疗需要持续超过12个月。
