Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK.
Nat Rev Endocrinol. 2020 Aug;16(8):437-447. doi: 10.1038/s41574-020-0341-0. Epub 2020 Apr 14.
Glucocorticoids are widely used to suppress inflammation or the immune system. High doses and long-term use of glucocorticoids lead to an important and common iatrogenic complication, glucocorticoid-induced osteoporosis, in a substantial proportion of patients. Glucocorticoids mainly increase bone resorption during the initial phase (the first year of treatment) by enhancing the differentiation and maturation of osteoclasts. Glucocorticoids also inhibit osteoblastogenesis and promote apoptosis of osteoblasts and osteocytes, resulting in decreased bone formation during long-term use. Several indirect effects of glucocorticoids on bone metabolism, such as suppression of production of insulin-like growth factor 1 or growth hormone, are involved in the pathogenesis of glucocorticoid-induced osteoporosis. Fracture risk assessment for all patients with long-term use of oral glucocorticoids is required. Non-pharmacological interventions to manage the risk of fracture should be prescribed to all patients, while pharmacological management is reserved for patients who have increased fracture risk. Various treatment options can be used, ranging from bisphosphonates to denosumab, as well as teriparatide. Finally, appropriate monitoring during treatment is also important.
糖皮质激素被广泛用于抑制炎症或免疫系统。在很大一部分患者中，高剂量和长期使用糖皮质激素会导致一种重要且常见的医源性并发症，即糖皮质激素诱导的骨质疏松症。糖皮质激素主要通过增强破骨细胞的分化和成熟，在初始阶段（治疗的第一年）增加骨吸收。糖皮质激素还抑制成骨细胞的生成，并促进成骨细胞和骨细胞的凋亡，导致长期使用期间骨形成减少。糖皮质激素对骨代谢的一些间接影响，如抑制胰岛素样生长因子 1或生长激素的产生，参与了糖皮质激素诱导的骨质疏松症的发病机制。所有长期口服糖皮质激素治疗的患者都需要进行骨折风险评估。应向所有患者开具管理骨折风险的非药物干预措施，而药物治疗则保留给骨折风险增加的患者。可以使用各种治疗选择，从双膦酸盐到地舒单抗，以及特立帕肽。最后，治疗期间的适当监测也很重要。
