Masaki Hideki, Miki Takami
Osaka City University Medical School, Postgraduate School of Geriatric Medicine.
Clin Calcium. 2006 Nov;16(11):1823-32.
The pathogenesis of steroid (glucocorticoid)-induced bone loss is still unclear. But, bone formation is known to be quickly decreased in early stage of steroid administration, followed by reduction of bone resorption. The reductions of bone resorption markers are small if low dose of steroid is administered, and the changes are accelerated dose dependently, probably due to secondary hyperparathyroidism. The short term intravenous administration of steroid induces transient suppression of bone turnover even in high dose administration. Therefore, it seems that the degree of changes in bone turnover markers induced by steroid is affected not only by the dosage but also by the period of steroid administration. The reduction of osteocalcin is more sensitive than bone alkaline phosphatase for the detection of the suppression of bone formation, although metabolism of osteocalcin induced by steroid may influence the change.
类固醇（糖皮质激素）诱导性骨质流失的发病机制仍不清楚。但是，已知在使用类固醇的早期骨形成会迅速减少，随后骨吸收也会降低。如果给予低剂量类固醇，骨吸收标志物的降低幅度较小，且这些变化呈剂量依赖性加速，这可能是由于继发性甲状旁腺功能亢进所致。即使给予高剂量类固醇，短期静脉注射类固醇也会诱导骨转换的短暂抑制。因此，似乎类固醇诱导的骨转换标志物变化程度不仅受剂量影响，还受类固醇给药时间的影响。尽管类固醇诱导的骨钙素代谢可能会影响其变化，但骨钙素的降低比骨碱性磷酸酶对检测骨形成抑制更为敏感。
