Verhoeven A C, Boers M
Department of Internal Medicine/Rheumatology, Maastricht University Hospital, The Netherlands.
J Rheumatol. 1997 Aug;24(8):1495-503.
To clarify the relation between changes in bone density, the treated disease, and dose of corticosteroids prescribed.
MEDLINE database (1966-95) and bibliographic searches selected cohorts of patients with rheumatoid arthritis (RA) and non-RA patients, studied by reliable serial bone density measurements.
Two randomized controlled trials in early RA found greater lumbar bone loss after corticosteroid treatment (pooled effect size at 6 mo 3.9%; 95% CI: 1.9, 6.0%). The other studies included 66 patients with RA taking mean 7 mg prednisone/day; 371 "untreated" RA patients; and 216 non-RA patients taking mean 20 mg prednisone/day. Lumbar bone mass changed (weighted mean) 0.0% (-0.6, 0.7%) per year in steroid treated RA, -0.6% (-0.9, -0.2%) in untreated RA, and -4.7% (-5.2, -4.3%) in non-RA. Femoral neck changed -3.0% (-4.2, -1.8%), -0.7% (-1.0, -0.3%), and -1.5% (-2.5, -0.4%), respectively. In RA, most bone was lost in the first half year, and in early or uncontrolled disease.
In patients with RA bone loss is limited, influenced by the interaction of disease characteristics and low dose corticosteroid therapy. In contrast, non-RA patients taking higher doses of corticosteriods may loss clinically relevant amounts of bone (i.e., > 5%) within one year.
阐明骨密度变化、所治疗的疾病与所开具的皮质类固醇剂量之间的关系。
利用MEDLINE数据库（1966 - 1995年）并通过文献检索选择类风湿关节炎（RA）患者队列及非RA患者，采用可靠的连续骨密度测量方法进行研究。
两项针对早期RA的随机对照试验发现，皮质类固醇治疗后腰椎骨量丢失更多（6个月时合并效应量为3.9%；95%可信区间：1.9，6.0%）。其他研究纳入了66例平均每日服用7毫克泼尼松的RA患者；371例“未治疗”的RA患者；以及216例平均每日服用20毫克泼尼松的非RA患者。接受类固醇治疗的RA患者腰椎骨量每年变化（加权均值）为0.0%（-0.6，0.7%），未治疗的RA患者为-0.6%（-0.9，-0.2%），非RA患者为-4.7%（-5.2，-4.3%）。股骨颈骨量变化分别为-3.0%（-4.2，-1.8%）、-0.7%（-1.0，-0.3%）和-1.5%（-2.5，-0.4%）。在RA患者中，大部分骨量在上半年丢失，且在疾病早期或未得到控制时丢失。
在RA患者中，骨量丢失有限，受疾病特征与低剂量皮质类固醇治疗相互作用的影响。相比之下，服用较高剂量皮质类固醇的非RA患者可能在一年内丢失临床上相关量的骨（即>5%）。
