Eastell R, Reid D M, Compston J, Cooper C, Fogelman I, Francis R M, Hosking D J, Purdie D W, Ralston S H, Reeve J, Russell R G, Stevenson J C, Torgerson D J
University of Sheffield Medical School, UK.
J Intern Med. 1998 Oct;244(4):271-92. doi: 10.1046/j.1365-2796.1998.00408.x.
In the UK, over 250 000 patients take continuous oral glucocorticoids (GCs), yet no more than 14% receive any therapy to prevent bone loss, a major complication of GC treatment. Bone loss is rapid, particularly in the first year, and fracture risk may double. This review, based wherever possible on clinical evidence, aims to provide easy-to-use guidance with wide applicability. A treatment algorithm is presented for adults receiving GC doses of 7.5 mg day(-1) or more for 6 months or more. General measures, e.g. alternative GCs and routes of administration, and therapeutic interventions, e.g. cyclical etidronate and hormone replacement, are recommended.
在英国,超过25万名患者持续口服糖皮质激素(GCs),但接受预防骨质流失治疗的患者不超过14%,而骨质流失是GC治疗的主要并发症。骨质流失迅速,尤其是在第一年,骨折风险可能会加倍。本综述尽可能基于临床证据,旨在提供适用性广泛且易于使用的指导。文中给出了针对接受每日7.5毫克或更高剂量GC且疗程达6个月或更长时间的成年人的治疗算法。推荐了一些常规措施,如选用其他GCs及给药途径,以及治疗干预措施,如周期性使用依替膦酸盐和激素替代疗法。