The Skeletal Effects of Inhaled Glucocorticoids.
The Skeletal Effects of Inhaled Glucocorticoids.
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DOI：
10.1007/s11914-016-0308-1
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发表时间：
2016-06
影响因子：
4.3
通讯作者：
Stein EM
中科院分区：
文献类型：
--
作者：
Sutter SA;Stein EM
吸入糖皮质激素对骨骼的影响知之甚少。吸入糖皮质激素治疗的哮喘儿童的生长速度、骨密度和成人身高较低。对成人哮喘患者的研究已经报道了对骨密度的不同影响，尽管前瞻性研究表明，绝经前妇女开始吸入糖皮质激素后会发生骨丢失。吸入糖皮质激素与哮喘患者的骨折风险之间存在剂量反应关系；在大多数研究中，接受最高剂量治疗的受试者发生椎体和非椎体骨折的风险更大。与对照组相比，COPD患者的骨密度较低，骨折发生率较高，然而，大多数研究尚未发现吸入糖皮质激素对骨骼的额外有害影响。虽然证据不是决定性的，但它支持使用尽可能低剂量的吸入性糖皮质激素来治疗哮喘和COPD患者，并强调了对这一主题进行进一步研究的必要性。
The skeletal effects of inhaled glucocorticoids are poorly understood. Children with asthma treated with inhaled glucocorticoids have lower growth velocity, bone density, and adult height. Studies of adults with asthma have reported variable effects on BMD, although prospective studies have demonstrated bone loss after initiation of inhaled glucocorticoids in premenopausal women. There is a dose response relationship between inhaled glucocorticoids and fracture risk in asthmatics; the risk of vertebral and non-vertebral fractures is greater in subjects treated with the highest doses in the majority of studies. Patients with COPD have lower BMD and higher fracture rates compared to controls, however, the majority of studies have not found an additional detrimental effect of inhaled glucocorticoids on bone. While the evidence is not conclusive, it supports using the lowest possible dose of inhaled glucocorticoids to treat patients with asthma and COPD and highlights the need for further research on this topic.