Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Curr Osteoporos Rep. 2021 Feb;19(1):34-39. doi: 10.1007/s11914-020-00653-9. Epub 2021 Jan 7.
We aim to critically review recent recommendations regarding preventative strategies for glucocorticoid-induced osteoporosis and provide a summary of key evidence regarding available interventions.
Lifestyle optimization remains the hallmark of bone health preservation. Early initiation of anti-osteoporotic agents in the setting of glucocorticoid exposure is essential, guided by appropriate risk stratification. Recommendations for calcium and vitamin D intake optimization are well-supported across all risk strata. Bisphosphonates are the mainstay of pharmacological therapy. Newer agents such as denosumab and teriparatide have demonstrated comparative benefit in terms of incident fracture risk reduction and bone mineral density preservation, with comparable adverse events. With due consideration to cost, resource availability, and patient values and preferences, these agents may warrant use as the first-line agents in this setting. Glucocorticoid-induced osteoporosis remains preventable and warrants early and targeted evidence-based therapy.
我们旨在批判性地回顾最近关于预防糖皮质激素诱导性骨质疏松症的建议，并对现有干预措施的关键证据进行总结。
生活方式的优化仍然是骨骼健康保护的关键。在糖皮质激素暴露的情况下，早期开始使用抗骨质疏松药物至关重要，这需要进行适当的风险分层。在所有风险分层中，钙和维生素 D 摄入的优化建议都得到了很好的支持。双膦酸盐是药物治疗的基础。地舒单抗和特立帕肽等新型药物在降低骨折风险和骨密度方面具有相似的疗效，且不良事件相当。在充分考虑成本、资源可用性以及患者的价值观和偏好的情况下，这些药物可能值得在这种情况下作为一线药物使用。糖皮质激素诱导性骨质疏松症仍然是可以预防的，需要早期和有针对性的循证治疗。
