van Staa T P
Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Calcif Tissue Int. 2006 Sep;79(3):129-37. doi: 10.1007/s00223-006-0019-1. Epub 2006 Sep 11.
Oral glucocorticoids (GCs) are frequently used in the treatment of inflammatory conditions, such as rheumatoid arthritis or asthma. They have adverse skeletal effects, primarily through reductions in bone formation and osteocyte apoptosis. Several findings indicate that changes in the quality of bone may significantly contribute to the increased risk of fracture and that loss of BMD only partially explains the increased risk of fracture in oral GC users. Epidemiological studies have found that the increases in the risk of fracture in oral GC users are dose dependent and occur within three months of starting GC therapy. Daily doses of >2.5 mg prednisone equivalent have been associated with increases in the risk of fractures and randomised studies reported adverse skeletal effects with daily doses as low as 5 mg. After discontinuation of GC treatment, the risk of fracture may reduce towards baseline levels unless patients previously used high cumulative doses of oral GCs. Users of inhaled GCs have also an increased risk of fracture, especially at higher doses. But it is likely that this excess risk is related to the severity of the underlying respiratory disease, rather than to the inhaled GC therapy. It has been recommended that patients who start on oral GC therapy should receive calcium and vitamin D supplementation. Patients with a higher risk of fracture should also receive a bisphosphonate.
口服糖皮质激素（GCs）常用于治疗炎症性疾病，如类风湿性关节炎或哮喘。它们对骨骼有不良影响，主要是通过减少骨形成和骨细胞凋亡。多项研究结果表明，骨质量的变化可能显著增加骨折风险，而骨密度降低仅部分解释了口服GCs使用者骨折风险增加的原因。流行病学研究发现，口服GCs使用者骨折风险的增加呈剂量依赖性，且在开始GC治疗后的三个月内就会出现。每日剂量大于2.5毫克泼尼松等效剂量与骨折风险增加相关，随机研究报告称，每日剂量低至5毫克也会对骨骼产生不良影响。停用GC治疗后，骨折风险可能会降至基线水平，除非患者之前曾使用过高累积剂量的口服GCs。吸入性GCs使用者的骨折风险也会增加，尤其是在高剂量使用时。但这种额外风险可能与潜在呼吸系统疾病的严重程度有关，而非与吸入性GC治疗有关。建议开始口服GC治疗的患者补充钙和维生素D。骨折风险较高的患者还应接受双膦酸盐治疗。
