Perrot Serge, Le Jeunne Claire
Université Paris Descartes, Hôtel-Dieu, service de médecine interne et thérapeutique, Inserm U 987, 75004 Paris, France.
Presse Med. 2012 Apr;41(4):406-13. doi: 10.1016/j.lpm.2012.01.003. Epub 2012 Feb 7.
Bone-related steroid involvement is one of the most frequent complications of steroid treatment. Epidemiological data demonstrate that osteoporosis starts early during the treatment, predominantly involves trabecular bone and is correlated to dosage and treatment duration. Mechanisms and consequences of steroid bone involvement are related to osseous and extra-osseous mechanisms. In clinical practice, steroid-induced osteoporosis remains underdiagnosed and undertreated both in preventive and curative approaches. Recently, new molecules as teriparatide and zoledronic acid got indication for the treatment of steroid-induced osteoporosis. To guide treatment strategies, several recommendations are available: French, not updated recommendations since 2003 (Afssaps, 2003), European elaborated by the EULAR in 2007 and those of the ACR updated in 2010.
与骨相关的类固醇影响是类固醇治疗最常见的并发症之一。流行病学数据表明，骨质疏松在治疗早期就开始出现，主要累及小梁骨，且与剂量和治疗持续时间相关。类固醇对骨的影响机制和后果与骨内和骨外机制有关。在临床实践中，无论是预防还是治疗方面，类固醇诱导的骨质疏松仍未得到充分诊断和治疗。最近，特立帕肽和唑来膦酸等新分子已被批准用于治疗类固醇诱导的骨质疏松。为指导治疗策略，有多项建议可供参考：法国的建议自2003年以来未更新（法国卫生安全与健康产品局，2003年），欧洲抗风湿病联盟（EULAR）在2007年制定的建议，以及美国风湿病学会（ACR）在2010年更新的建议。
