Kocián J
I. interní klinika IPVZ FTN, Praha.
Vnitr Lek. 1998 Feb;44(2):86-92.
The author demonstrates on a group of 292 patients (207 women, 85 men) treated on account of various diseases with corticoids laboratory parameters and bone density and records of bone fractures. The bone metabolism is negatively influenced by the action of corticoids on the vitamin D transformation into its active metabolites; as a result of reduced calcium absorption from the gut the reduced calcium level in blood causes secondary hyperparathyroidism and osteoclastic bone resorption is enhanced. On the other hand, corticoids inhibit new formation of bone by suppressing the proliferation of osteoblasts and by interfering with osteoid formation. One quarter of the patients suffers moreover from osteoporomalacia. Two and a half times as many women have steroid osteoporosis, and bone demineralization is enhanced also by other factors caused by the basic disease (immobilization, hypercalciuria, lactose intolerance). By comprehensive treatment using a combination of Ca + F, vitamin D, exercise, thyrocalcitonin, Osteogenon and recently also the third series of bisphosphonates it proved possible to increase within one year the bone density on average by 4.5% of normal values. The number of fractures declined dramatically.
作者对292例因各种疾病接受皮质激素治疗的患者（207名女性，85名男性）进行了实验室参数、骨密度及骨折记录方面的研究。皮质激素作用于维生素D向其活性代谢产物的转化，从而对骨代谢产生负面影响；由于肠道对钙的吸收减少，血液中钙水平降低，导致继发性甲状旁腺功能亢进，破骨细胞性骨吸收增强。另一方面，皮质激素通过抑制成骨细胞的增殖和干扰类骨质形成来抑制新骨形成。此外，四分之一的患者患有骨质疏松症。患类固醇性骨质疏松症的女性人数是男性的2.5倍，基础疾病导致的其他因素（固定不动、高钙尿症、乳糖不耐受）也会加剧骨质脱矿。通过联合使用钙+氟、维生素D、运动、降钙素、骨生成素以及最近的第三代双膦酸盐进行综合治疗，结果显示在一年内骨密度平均可提高至正常值的4.5%。骨折数量大幅下降。
