Kesikburun S, Güzelküçük U, Alay S, Yavuz F, Tan A K
Department of PM&R, Turkish Armed Forces Rehabilitation Center, Gülhane Military Medical Academy, Ankara, Turkey,
Osteoporos Int. 2014 Sep;25(9):2319-20. doi: 10.1007/s00198-014-2768-4. Epub 2014 Jun 17.
Myasthenia gravis is an important indication for the long-term prescription of corticosteroids. We present a patient with myasthenia gravis who had worsening of symptoms associated with the use of alendronate. A 24-year-old patient with myasthenia gravis had been administered oral systemic corticosteroid (deflazacort 40 mg/day) for 3 years in order to control his myasthenic symptoms. One year earlier, his lumbar spine bone mineral density was decreased. He was started on oral calcium/vitamin D3 and alendronate (70-mg tablets once a week) for osteoporosis. He reported an exacerbation of muscle weakness and extreme fatigue on days when he took alendronate. He could not work on these days and has to be on leave. Alendronate was stopped, and he was started on intravenous ibandronate injections given every 3 months. He did not experience muscle weakness and fatigue with ibandronate therapy. Alendronate should be used with caution in patients with myasthenia gravis who have corticosteroid-induced osteoporosis.
重症肌无力是长期使用皮质类固醇激素的重要指征。我们报告一例重症肌无力患者，其症状加重与使用阿仑膦酸盐有关。一名24岁的重症肌无力患者为控制肌无力症状，已口服全身性皮质类固醇（地夫可特40毫克/天）3年。一年前，他的腰椎骨密度降低。他开始口服钙/维生素D3和阿仑膦酸盐（每周70毫克片剂一次）治疗骨质疏松症。他报告在服用阿仑膦酸盐的日子里，肌肉无力和极度疲劳加重。在这些日子里他无法工作，不得不请假。停用阿仑膦酸盐，开始每3个月静脉注射一次伊班膦酸盐。接受伊班膦酸盐治疗时，他没有出现肌肉无力和疲劳。对于患有皮质类固醇诱导骨质疏松症的重症肌无力患者，应谨慎使用阿仑膦酸盐。
