University of Cambridge School of Clinical Medicine, Department of Medicine, Addenbrooke's Hospital, Cambridge, UK.
Nat Rev Rheumatol. 2010 Feb;6(2):82-8. doi: 10.1038/nrrheum.2009.259.
Glucocorticoid-induced osteoporosis is a common condition that results in significant morbidity and mortality. The skeletal effects of glucocorticoids include both direct and indirect actions on bone that result in an early, transient increase in bone resorption accompanied by a decrease in bone formation, which is maintained for the duration of glucocorticoid therapy. Rapid bone loss and increased fracture risk occur soon after the initiation of glucocorticoid therapy and are dose dependent. The increase in fracture risk is partly independent of bone mineral density, probably as a result of changes in bone material properties and an increased risk of falling. Bisphosphonates are the front-line choice for prevention of fracture in glucocorticoid-treated patients, with teriparatide as the second-line option; calcium and vitamin D supplements should be co-prescribed in the majority of individuals. Future guidelines for the management of glucocorticoid-induced osteoporosis should recognize the limitations of FRAX in assessing fracture risk in glucocorticoid-treated patients, and should include recently approved interventions, such as zoledronate and teriparatide.
糖皮质激素诱导性骨质疏松症是一种常见病症，可导致严重的发病率和死亡率。糖皮质激素对骨骼的影响包括对骨骼的直接和间接作用，导致早期短暂的骨吸收增加，同时伴随着骨形成减少，这种情况在糖皮质激素治疗期间持续存在。糖皮质激素治疗开始后不久，就会出现快速的骨丢失和骨折风险增加，且与剂量相关。骨折风险的增加部分独立于骨密度，可能是由于骨物质特性的变化和跌倒风险的增加所致。双膦酸盐是糖皮质激素治疗患者预防骨折的一线选择，特立帕肽是二线选择；大多数患者应同时开具钙和维生素 D 补充剂。未来糖皮质激素诱导性骨质疏松症管理指南应认识到 FRAX 在评估糖皮质激素治疗患者骨折风险方面的局限性，并应包括最近批准的干预措施，如唑来膦酸和特立帕肽。
