Department of Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0SL, UK.
Endocrine. 2018 Jul;61(1):7-16. doi: 10.1007/s12020-018-1588-2. Epub 2018 Apr 24.
Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis and the resulting fractures cause significant morbidity. Following initiation of oral glucocorticoids, rapid bone loss occurs, and fracture risk increases within a few months in a dose-dependent manner. These adverse effects are due to inhibition of bone formation accompanied by an early but transient increase in bone resorption. Multiple mechanisms underlie these changes in bone remodeling; direct effects include upregulation of PPARγR2, increased expression of sclerostin and increased RANKL/OPG ratio, whilst hypogonadism, altered renal and intestinal calcium handling, and reduced production of insulin-like growth factor 1 also contribute. Fracture risk assessment should be performed as soon as possible after glucocorticoids are initiated and bone protective therapy started promptly in individuals at high-risk, with calcium and vitamin D supplements where appropriate. Oral bisphosphonates are currently regarded as first line options on the grounds of their low cost. However, teriparatide has been shown to be superior in its effects on BMD and vertebral fracture risk in glucocorticoid-treated individuals with osteoporosis and should be considered as an alternative first line option in high-risk patients.
糖皮质激素诱导性骨质疏松症是最常见的继发性骨质疏松症，由此导致的骨折会引起显著的发病率。在开始口服糖皮质激素后，会迅速发生骨丢失，并且骨折风险会在几个月内呈剂量依赖性增加。这些不良反应是由于骨形成受到抑制，同时伴有早期但短暂的骨吸收增加。这些骨重建变化的基础是多种机制；直接作用包括 PPARγR2 的上调、骨硬化蛋白表达增加和 RANKL/OPG 比值增加，而性腺功能减退、钙代谢和胰岛素样生长因子 1 生成改变也有影响。一旦开始使用糖皮质激素，应尽快进行骨折风险评估，并在高风险个体中迅速开始进行骨保护治疗，酌情补充钙和维生素 D。鉴于其成本效益，目前口服双膦酸盐被认为是一线选择。然而，特立帕肽在治疗骨质疏松症的糖皮质激素治疗患者的骨密度和椎体骨折风险方面的效果更为优越，因此应被视为高风险患者的另一种一线选择。
