Tatsuno Ichiro, Sugiyama Takao, Suzuki Sawako, Yoshida Tomohiko, Tanaka Tomoaki, Sueishi Makoto, Saito Yasushi
Department of Clinical Cell Biology, Chiba University Graduate School of Medicine, Japan.
J Clin Endocrinol Metab. 2009 May;94(5):1671-7. doi: 10.1210/jc.2008-1578. Epub 2009 Mar 3.
Collagen vascular diseases requiring treatment with high-dose glucocorticoids are frequently complicated by vertebral fracture. We investigated the incidence of symptomatic vertebral fractures for 20 yr among patients who were treated with high-dose glucocorticoids in the Chiba-Shimoshizu Rheumatic Cohort.
A total of 2631 patients with collagen vascular diseases (aged >or=18 yr) was registered between 1986 and 2006. The prevalence of symptomatic vertebral fracture was compared between the high-dose glucocorticoid group newly treated with high-dose glucocorticoids (>or=20 mg/d prednisolone equivalent) (n = 700), and the non-glucocorticoid controls not treated with glucocorticoids (n = 194).
During the 20-yr study period, symptomatic vertebral fractures occurred more frequently in the high-dose glucocorticoid group (23.9%) than in the non-glucocorticoid controls (2.6%). According to a Kaplan-Meier analysis, the cumulative incidence of symptomatic vertebral fracture was significantly higher in the high-dose glucocorticoid group than in the non-glucocorticoid controls (P < 0.001). Stratified into age quartiles of the high-dose glucocorticoid group (age 18-31, 32-47, 48-59, and 60-88 yr), the patients had a markedly increased incidence of symptomatic vertebral fracture with aging. The hazard ratios were also significantly higher in the older age quartile of 60-68 than in the younger age quartile of 32-47 (P < 0.001 for trend). The hazard ratio was 26-fold higher in patients aged 60-88 than in patients aged 18-31 (P < 0.01). In the group with fractures, the treatment duration before fracture was negatively associated with the initial age (r = -0.6587; P < 0.001).
The prevalence of symptomatic vertebral fractures was higher in the patients treated with high-dose glucocorticoids than the untreated controls. Vertebral fractures were age dependent in patients treated with high-dose glucocorticoids. Treatment duration before fracture incidence was significantly shorter in the older patients.
需要大剂量糖皮质激素治疗的胶原血管病常并发椎体骨折。我们调查了千叶 - 下清水风湿队列中接受大剂量糖皮质激素治疗的患者20年间有症状椎体骨折的发生率。
1986年至2006年间共登记了2631例胶原血管病患者（年龄≥18岁）。比较新接受大剂量糖皮质激素治疗（泼尼松等效剂量≥20mg/d）的大剂量糖皮质激素组（n = 700）和未接受糖皮质激素治疗的非糖皮质激素对照组（n = 194）中有症状椎体骨折的患病率。
在20年的研究期间，有症状椎体骨折在大剂量糖皮质激素组（23.9%）中的发生频率高于非糖皮质激素对照组（2.6%）。根据Kaplan-Meier分析，大剂量糖皮质激素组有症状椎体骨折的累积发生率显著高于非糖皮质激素对照组（P < 0.001）。将大剂量糖皮质激素组按年龄四分位数分层（年龄18 - 31岁、32 - 47岁、48 - 59岁和60 - 88岁），患者有症状椎体骨折的发生率随年龄增长显著增加。60 - 68岁年龄较大的四分位数组的风险比也显著高于32 - 47岁年龄较小的四分位数组（趋势P < 0.001）。60 - 88岁患者的风险比是18 - 31岁患者的26倍（P < 0.01）。在骨折组中，骨折前的治疗持续时间与初始年龄呈负相关（r = -0.6587；P < 0.001）。
接受大剂量糖皮质激素治疗的患者中有症状椎体骨折的患病率高于未治疗的对照组。大剂量糖皮质激素治疗的患者椎体骨折与年龄有关。老年患者骨折发生前的治疗持续时间明显较短。
