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慢性疾病中的糖皮质激素:有好有坏,还有骨骼。

GLUCOCORTICOIDS IN CHRONIC DISEASE: THE GOOD, THE BAD, THE BONE.

机构信息

Birmingham, Alabama.

出版信息

Trans Am Clin Climatol Assoc. 2023;133:69-80.

Abstract

Despite the advent of more targeted therapies, glucocorticoids (steroids) remain in chronic use (defined as > 3 months or more) by an estimated 0.5% of the population. Steroids yield symptomatic benefits for systemic and local inflammation as well as disease-modifying properties in rheumatoid arthritis, the most common disorder for their chronic use. Despite their many benefits, steroids have been associated with a myriad of common side effects. Observational studies of steroid safety are limited by confounding by indication, and randomized controlled trials have been too short and too small to understand their true safety profile. Glucocorticoid-induced osteoporosis (GIOP) occurs in a time- and dose-dependent way and is associated with both a reduction in bone formation and an increase in bone resorption. Numerous anti-osteoporotic therapies have efficacy for improving bone health among chronic glucocorticoid users, but implementation science approaches are needed to achieve adequate GIOP prevention and to reduce fracture outcomes.

摘要

尽管出现了更具针对性的治疗方法,但估计仍有 0.5%的人口长期使用(定义为 > 3 个月或更长时间)糖皮质激素(类固醇)。类固醇在类风湿关节炎中具有缓解全身和局部炎症以及疾病改善特性的症状益处,这是其慢性使用最常见的疾病。尽管它们有许多益处,但类固醇已与许多常见的副作用相关。类固醇安全性的观察性研究受到指示性混杂的限制,随机对照试验时间太短,规模太小,无法了解其真正的安全性概况。糖皮质激素诱导的骨质疏松症(GIOP)呈时间和剂量依赖性,与骨形成减少和骨吸收增加有关。许多抗骨质疏松症治疗方法对改善慢性使用糖皮质激素患者的骨骼健康有效,但需要实施科学方法来充分预防 GIOP 并降低骨折结局。

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Ukrainian guideline for the prevention and treatment of glucocorticoid-induced osteoporosis.
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