Soen Satoshi
Department of Orthopaedic Surgery and Rheumatology, Nara Hospital, Kinki University School of Medicine, Japan.
Clin Calcium. 2012 Feb;22(2):229-35.
Glucocorticoid-induced osteoporosis is one of the most important side effects of glucocorticoid use, as it leads to an increased risk of fracture. 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 increase fracture risk occur soon after the initiation of glucocorticoid therapy and 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. Fracture risk can be assessed using the FRAX(®) algorithm, although risk may be underestimated in patients taking higher doses of glucocorticoids.
糖皮质激素诱导的骨质疏松症是使用糖皮质激素最重要的副作用之一，因为它会导致骨折风险增加。糖皮质激素对骨骼的影响包括对骨骼的直接和间接作用，导致骨吸收早期短暂增加，同时骨形成减少，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骨质流失和骨折风险增加，且与剂量相关。骨折风险的增加部分独立于骨密度，这可能是骨材料特性变化和跌倒风险增加的结果。双膦酸盐是糖皮质激素治疗患者预防骨折的一线选择，特立帕肽为二线选择；大多数患者应同时开具钙和维生素D补充剂。虽然使用FRAX(®)算法可以评估骨折风险，但在服用高剂量糖皮质激素的患者中，风险可能被低估。
