Department of Rheumatology and Clinical Immunology, Maasstad hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
Bravis hospital, Boerhaaveplein 1, 4624 VT, Bergen op Zoom and Boerhaavelaan 25, 4708 AE, Roosendaal, The Netherlands.
Calcif Tissue Int. 2018 May;102(5):592-606. doi: 10.1007/s00223-017-0335-7. Epub 2018 Jan 8.
The current review on glucocorticoids (GCs), inflammation and bone is focused on three aspects: (1) the mutual effects between GCs, inflammation and bone in inflammatory rheumatic diseases, (2) current views on fracture risk assessment in patients using GCs and (3) non-pharmacological and pharmacological treatment to prevent fractures in GC-using patients with inflammatory rheumatic diseases. The use of GCs results in increased risk for fractures due to both direct and indirect negative effects of GCs on bone mass, and on bone and muscle strength. However, also the underlying inflammatory rheumatic disease is associated with the increased bone loss and fracture risk due to the chronic inflammation itself, and due to disability/immobility caused by active disease or joint destruction. The rapid and strong anti-inflammatory effect of GCs in patients with rheumatoid arthritis seems to balance the negative effects of GCs on bone in the early, active phase of the disease. Recently, an update of the American College of Rheumatology guidelines for prevention and treatment of GC-induced osteoporosis was published with renewed recommendations. To prevent fractures, general measures, including treatment of the underlying inflammatory disease adequately (even with GCs when indicated), a healthy lifestyle, including adequate calcium and vitamin D supplementation, and regular weight bearing exercises are important. In rheumatic patients with high fracture risk using GCs, especially when the cumulative dose is high and/or the underlying inflammatory disease is active, treatment with anti-osteoporotic drugs, usually an oral bisphosphonate, is indicated.
当前关于糖皮质激素（GCs）、炎症和骨骼的综述集中在三个方面：（1）在炎症性风湿病中 GCs、炎症和骨骼之间的相互作用，（2）目前对使用 GCs 的患者骨折风险评估的看法，以及（3）预防炎症性风湿病中使用 GCs 的患者发生骨折的非药物和药物治疗。GC 的使用会导致骨折风险增加，这是由于 GCs 对骨量、骨骼和肌肉强度产生直接和间接的负面影响。然而，炎症性风湿病本身的慢性炎症以及疾病活动或关节破坏引起的残疾/活动受限，也会导致骨丢失和骨折风险增加。GC 在类风湿关节炎患者中的快速和强大的抗炎作用似乎在疾病的早期、活动期平衡了 GCs 对骨骼的负面影响。最近，美国风湿病学会发布了更新的预防和治疗 GC 诱导性骨质疏松症指南，提出了新的建议。为了预防骨折，一般措施包括充分治疗基础炎症性疾病（即使需要使用 GCs）、健康的生活方式，包括充足的钙和维生素 D 补充以及定期负重运动也很重要。对于使用 GCs 且骨折风险高的风湿病患者，尤其是当累积剂量高且/或基础炎症性疾病活跃时，应使用抗骨质疏松药物治疗，通常是口服双膦酸盐。
