预防和治疗与糖皮质激素暴露相关的骨骼变化。
Prevention and treatment of bone changes associated with exposure to glucocorticoids.
机构信息
Division of Endocrinology, Metabolism and Diabetes, University of Alabama at Birmingham, 702 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35233, USA,
出版信息
Curr Osteoporos Rep. 2013 Dec;11(4):341-7. doi: 10.1007/s11914-013-0173-0.
Rheumatologic diseases are associated with a proinflammatory state, which is thought to lead to many of the bone changes seen in treatment-naive patients. However, glucocorticoids remain a common treatment option for rheumatologic diseases and are known to have a negative impact on bone through direct effects on bone cells and indirect effects on calcium absorption. Despite the anti-inflammatory effect of glucocorticoids, fracture risk rises within the first 3 months of treatment. As such, osteoporosis prevention and treatment needs to be considered in all patients started on chronic glucocorticoids (≥3 months of treatment). For very low risk patients, conservative management with non-pharmacologic strategies may be appropriate. For the moderate to high fracture risk patients treated with glucocorticoids, pharmacologic treatment with 1 of the 4 approved medications should be considered. The challenge of educating physicians and patients of the risks of glucocorticoid induced osteoporosis remain.
风湿性疾病与促炎状态有关，据认为这会导致许多未经治疗的患者出现骨改变。然而，糖皮质激素仍然是治疗风湿性疾病的常用方法，已知其通过直接作用于骨细胞和间接作用于钙吸收对骨骼产生负面影响。尽管糖皮质激素具有抗炎作用，但在治疗的头 3 个月内骨折风险就会上升。因此，需要考虑所有开始接受慢性糖皮质激素治疗（≥3 个月）的患者预防和治疗骨质疏松症。对于风险非常低的患者，可能适合采用非药物策略的保守治疗。对于接受糖皮质激素治疗、骨折风险处于中到高度的患者，应考虑使用批准的 4 种药物之一进行药物治疗。教育医生和患者了解糖皮质激素引起的骨质疏松症的风险仍然是一个挑战。
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