Chicago Medical School, Rosalind Franklin University of Science and Medicine, North Chicago, IL, USA.
Am J Rhinol Allergy. 2010 May-Jun;24(3):215-9. doi: 10.2500/ajra.2010.24.3445.
The treatment of chronic rhinosinusitis (CRS) often requires chronic or intermittent oral steroid therapy, which has the potential for adverse skeletal effects, including osteoporosis and increased risk of fragility fractures. The purpose of this study was to determine the prevalence of osteopenia/osteoporosis (OP) or low bone density (LBD) in patients with CRS with/without polyposis treated with oral glucocorticoids.
Retrospective chart analysis was performed at a tertiary-care rhinology practice. Patients with CRS with/without polyposis evaluated between September 2003 and July 2008 were included if they had (1) previous history of oral steroid usage (> or =5 mg daily for at least 3 months) and (2) previous bone mineral density evaluation.
A total of 197 patients were included with a mean age of 51.1 years (range, 15-79 years). The primary presenting diagnoses included CRS with polyposis in 176 cases (89.3%) and CRS without polyposis in 21 cases (10.7%). Concomitant asthma was present in 161 patients (81.7%). Overall, the prevalence of low bone mass was 38.6%. Among men >50 years of age and postmenopausal women, the prevalence of osteopenia/OP or LBD was 62.5 and 62.2%, respectively. Comparing men >50 years of age and postmenopausal women to their respective younger populations, both had a statistically higher presence of low bone mass (p < 0.0001), with an odds ratio of 10.6 (3.9-28.7) and 34.6 (7.4-161.5), respectively. There was no statistical difference in the presence of bone loss when comparing groups by gender. A multivariable analysis of common comorbidities revealed age to be the only factor associated with increased risk for OP/osteopenia or LBD.
Patients with CRS with/without polyposis treated with oral steroids who underwent bone density testing were found to have a high prevalence of LBD. High index of suspicion is required to identify at-risk patients and to initiate careful evaluation and treatment to prevent additional bone-related complications.
慢性鼻-鼻窦炎（CRS）的治疗常常需要长期或间歇性口服类固醇治疗，这可能对骨骼产生不良影响，包括骨质疏松症和脆性骨折风险增加。本研究旨在确定接受口服糖皮质激素治疗的伴有/不伴有息肉的 CRS 患者中，骨量减少/骨质疏松症（OP）或低骨密度（LBD）的患病率。
在一家三级护理鼻科诊所进行了回顾性图表分析。如果患者（1）有口服类固醇使用史（> =5mg/天，至少 3 个月）和（2）有先前的骨密度评估，则将患有 CRS 伴/不伴息肉的患者纳入 2003 年 9 月至 2008 年 7 月间进行评估。
共纳入 197 例患者，平均年龄为 51.1 岁（15-79 岁）。主要表现诊断包括 176 例（89.3%）伴有息肉的 CRS 和 21 例（10.7%）不伴有息肉的 CRS。161 例患者（81.7%）合并哮喘。总体而言，低骨量的患病率为 38.6%。50 岁以上男性和绝经后女性的骨质疏松症/OP 或 LBD 患病率分别为 62.5%和 62.2%。与年龄 50 岁以上的男性和绝经后女性相比，这两个群体的低骨量患病率均更高（p<0.0001），比值比分别为 10.6（3.9-28.7）和 34.6（7.4-161.5）。按性别比较时，两组之间的骨质流失发生率无统计学差异。对常见合并症的多变量分析显示，年龄是与 OP/骨质疏松症或 LBD 风险增加相关的唯一因素。
接受口服类固醇治疗的伴有/不伴有息肉的 CRS 患者进行骨密度测试时，发现 LBD 患病率较高。需要高度警惕，以识别高危患者，并进行仔细评估和治疗，以预防其他骨骼相关并发症。
