Terreaux F, Meunier P J
Service de rhumatologie et pathologie osseuse et Unité INSERM 234, hôpital Edouard-Herriot, Lyon.
Rev Prat. 1990 Feb 21;40(6):549-52.
Osteoporosis and epiphyseal aseptic bone necrosis are side-effects of corticosteroid therapy that must be detected and prevented. The incidence of osteoporosis depends on whether radiology or densitometry are used for its evaluation. Bone loss is accounted for by osteoblast depression and decreased intestinal absorption of calcium, responsible for secondary hyperparathyroidism. The clinical progress of steroid-induced osteoporosis is often impressive. Plasma osteocalcin levels are lowered. Nowadays, non-invasive methods of bone mass measurement are indispensable for detection and follow-up. Prevention rests on adjustment of corticosteroid therapy and, above all, on the prescription of calcium and vitamin D; fluoride constitutes the curative treatment. Corticosteroid dosage plays a role in the occurrence of aseptic bone necrosis at an early stage of treatment. The lesions, often multiple and progressive, mostly affect the femur. MRI is the most sensitive examination for early detection. When medical treatment has failed, total hip replacement may be considered.
骨质疏松症和骨骺无菌性骨坏死是皮质类固醇治疗的副作用，必须予以检测和预防。骨质疏松症的发病率取决于评估时使用的是放射学还是骨密度测定法。骨质流失是由成骨细胞抑制和肠道钙吸收减少导致的，这会引起继发性甲状旁腺功能亢进。类固醇诱导的骨质疏松症的临床进展通常很显著。血浆骨钙素水平降低。如今，非侵入性骨量测量方法对于检测和随访必不可少。预防措施在于调整皮质类固醇治疗，最重要的是补充钙和维生素D；氟化物是治疗药物。皮质类固醇剂量在治疗早期无菌性骨坏死的发生中起作用。这些病变通常是多发性且进行性的，大多影响股骨。MRI是早期检测最敏感的检查方法。当药物治疗无效时，可考虑进行全髋关节置换。
