School of Medicine, European University of Cyprus, Nicosia, Cyprus.
Univ. Lille, CHU Lille, MABlab ULR 4490, Department of Rheumatology, 59000, Lille, France.
Hormones (Athens). 2023 Dec;22(4):611-622. doi: 10.1007/s42000-023-00491-1. Epub 2023 Sep 27.
The widespread use of glucocorticoids (GCs) contributes to the effective management of several diseases and conditions. However, it comes at a price in the case of the bones causing glucocorticoid-induced osteoporosis (GIOP), the most common cause of secondary osteoporosis and fractures. Several scientific societies have issued comprehensive guidelines on the optimal management of patients receiving GCs with the aim of providing answers to three fundamental questions, namely, whom to treat, when to treat, and how to treat. Both common ground and different approaches exist among them. General preventive measures should start along with GC initiation, and the duration of GC therapy should be limited to the minimal effective range. A pre-existing fracture, age, gender, menopausal status, dose, and duration of GC treatment are key factors in the decision to initiate antiosteoporotic medication. Oral bisphosphonates are typically regarded as the first-line treatment choice for GIOP partly due to their cost-effectiveness. Denosumab is another valid option, but an "exit strategy" should be considered before its initiation due to the risk of rebound-associated vertebral fractures upon its discontinuation. Since impaired bone formation represents the main mechanism by which GCs negatively affect skeletal health, osteoanabolic therapies appear to be pathophysiologically the more appropriate and appealing option, although cost considerations currently limit their use to selected severe cases. Regardless of the agent selected to mitigate the impact of GCs on the skeleton, what is most crucial is that the treating physician correctly stratifies the risk and intervenes at the right time.
糖皮质激素（GCs）的广泛应用有助于有效治疗多种疾病和病症。然而，它也会对骨骼造成影响，导致糖皮质激素诱导的骨质疏松症（GIOP），这是继发性骨质疏松症和骨折的最常见原因。一些科学协会已经发布了关于接受 GCs 治疗的患者的最佳管理的综合指南，目的是为三个基本问题提供答案，即治疗谁、何时治疗以及如何治疗。它们之间既有共同点，也有不同的方法。一般预防措施应在开始使用 GC 时开始，GC 治疗的持续时间应限制在最小有效范围。预先存在的骨折、年龄、性别、绝经状态、GC 治疗的剂量和持续时间是决定开始抗骨质疏松药物治疗的关键因素。口服双膦酸盐由于其成本效益，通常被视为 GIOP 的一线治疗选择。地舒单抗是另一种有效的选择，但由于其停药后会出现与反弹相关的椎体骨折的风险，因此在开始使用前应考虑“退出策略”。由于 GC 对骨骼健康的负面影响主要是通过抑制骨形成来实现的，因此骨合成代谢治疗似乎在病理生理学上是更合适和更有吸引力的选择，尽管目前成本考虑因素限制了它们在选定的严重病例中的使用。无论选择哪种药物来减轻 GCs 对骨骼的影响，最重要的是治疗医生正确评估风险并在适当的时间进行干预。
