Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Endocrine. 2023 Dec;82(3):664-672. doi: 10.1007/s12020-023-03494-5. Epub 2023 Sep 7.
Weekly treatment with the intravenous glucocorticoid methylprednisolone for 12 weeks is mainstay in the treatment of Graves' orbitopathy but may decrease bone mass and impair bone structure. We therefore investigated bone turnover, -mass and -structure during the treatment cause in these patients.
We included 32 patients with Graves' orbitopathy scheduled for treatment with methylprednisolone. Bone turnover and thyroid function was measured at baseline and after 3, 9, 12, and 24 weeks, bone mineral density (BMD) was measured using dual x-ray absorptiometry at baseline and after 12 and 24 weeks, and bone structure was measured using high-resolution peripheral quantitative computed tomography at baseline and after 12 weeks.
Bone turnover and tri-iodothyronine decreased throughout the study. Cortical volumetric BMD at both the radius and tibia increased significantly by 0.98 ± 0.38% (p = 0.01) and 1.35 ± 0.50% (p = 0.01), respectively and cortical porosity at both the radius and tibia decreased significantly by -7.67 ± 3.13% (p = 0.04) and -3.30 ± 2.17% (p = 0.04), respectively. Bone mineral density was stable during the first 12 weeks but increased significantly by 2.26 ± 3.61% at the femoral neck (p < 0.01) and by 2.24 ± 4.24% at the total hip towards week 24 (p = 0.02). Stratified analyses suggested that remission of hyperthyroidism was the most important determinant of changes in bone turnover, bone mass and structure.
During a 12-week course of high-dose intravenous methylprednisolone bone turnover and cortical porosity decreased and during 24 weeks follow up bone mineral density increased. In terms of bone, methylprednisolone therefore is a safe treatment for Graves' orbitopathy.
静脉注射糖皮质激素甲泼尼龙每周治疗 12 周是格雷夫斯眼病治疗的基础，但可能会降低骨量并损害骨结构。因此，我们研究了这些患者在治疗过程中骨转换、骨量和骨结构的变化。
我们纳入了 32 例计划接受甲泼尼龙治疗的格雷夫斯眼病患者。在基线时和治疗后 3、9、12 和 24 周时测量骨转换和甲状腺功能，在基线时和治疗后 12 和 24 周时使用双能 X 线吸收法测量骨密度，在基线时和治疗后 12 周时使用高分辨率外周定量计算机断层扫描测量骨结构。
骨转换和三碘甲状腺原氨酸在整个研究过程中均下降。桡骨和胫骨的皮质容积骨密度分别显著增加 0.98±0.38%（p=0.01）和 1.35±0.50%（p=0.01），桡骨和胫骨的皮质孔隙率分别显著降低-7.67±3.13%（p=0.04）和-3.30±2.17%（p=0.04）。骨密度在最初 12 周内稳定，但在第 24 周时股骨颈处显著增加 2.26±3.61%（p<0.01），总髋部增加 2.24±4.24%（p=0.02）。分层分析表明，甲状腺功能亢进的缓解是骨转换、骨量和结构变化的最重要决定因素。
在为期 12 周的大剂量静脉注射甲泼尼龙治疗期间，骨转换和皮质孔隙率降低，在 24 周的随访期间，骨密度增加。就骨骼而言，甲泼尼龙是治疗格雷夫斯眼病的安全药物。
