Leipe Jan, Holle Julia U, Weseloh Christiane, Pfeil Alexander, Krüger Klaus
Sektion Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, München, Deutschland.
Z Rheumatol. 2021 Sep;80(7):670-687. doi: 10.1007/s00393-021-01028-w. Epub 2021 Aug 6.
Glucocorticoids are of substantial therapeutic importance in the treatment of inflammatory diseases, but are also associated with bone mineral density loss, osteoporosis, and fractures, especially with long-term use.
To develop recommendations for the management of glucocorticoid-induced osteoporosis (GIOP) in adult patients on long-term glucocorticoid (GC) treatment.
A systematic literature search (SLR) was conducted to synthesize the evidence for GIOP prevention and treatment options. Recommendations were developed based on SLR/level of evidence and by previously defined questions and in a structured group consensus process.
Recommendations include supplementation with calcium and vitamin D under long-term GC therapy in adults. If specific osteologic treatment is indicated, we recommend bisphosphonates or denosumab as first-line treatment. If fracture risk is high, we recommend teriparatide as primary specific osteologic treatment. Denosumab should be used in cases of severe renal insufficiency, and specific osteologic treatment should not be given in pregnancy. For patients who have not reached the treatment goal, a switch to another class of specific osteologic drugs should be performed. We recommend re-evaluation after a treatment duration of 3-5 years or after termination of long-term GC treatment.
This work aims to provide evidence-based and consensus-based recommendations for the best possible management of GIOP in Germany and to support treatment decisions.
糖皮质激素在炎症性疾病治疗中具有重要治疗意义，但长期使用也与骨矿物质密度降低、骨质疏松症和骨折相关。
为长期接受糖皮质激素（GC）治疗的成年患者制定糖皮质激素性骨质疏松症（GIOP）管理建议。
进行系统文献检索（SLR）以综合GIOP预防和治疗选择的证据。基于SLR/证据水平、先前定义的问题并通过结构化的小组共识过程制定建议。
建议包括在成人长期GC治疗期间补充钙和维生素D。如果需要进行特定的骨病治疗，我们推荐双膦酸盐或地诺单抗作为一线治疗。如果骨折风险高，我们推荐特立帕肽作为主要的特定骨病治疗。严重肾功能不全的病例应使用地诺单抗，妊娠期间不应给予特定的骨病治疗。对于未达到治疗目标的患者，应更换为另一类特定的骨病药物。我们建议在治疗3至5年或长期GC治疗结束后重新评估。
这项工作旨在为德国GIOP的最佳管理提供基于证据和共识的建议，并支持治疗决策。
