Advances in treatment of glucocorticoid-induced osteoporosis.
Advances in treatment of glucocorticoid-induced osteoporosis.
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DOI：
10.1097/med.0000000000000368
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发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Nanes M
中科院分区：
文献类型：
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作者：
Hsu E;Nanes M
总结长期糖皮质激素治疗患者糖皮质激素性骨质疏松的监测、预防和治疗方案。最近的荟萃分析强调了在长期使用糖皮质激素的情况下，双膦酸盐在改善骨密度和减少椎体骨折方面的疗效。一项新的研究表明，阿仑膦酸钠还可以降低使用糖皮质激素时髋部骨折的风险。新的数据表明，特立帕鲁肽和狄诺塞单抗也可降低糖皮质激素诱导的骨质疏松症中骨质疏松性骨折的风险。糖皮质激素的使用是继发性骨质疏松症的主要原因;然而，有糖皮质激素诱导的骨质疏松症风险的患者往往没有得到及时的评估或治疗。患者服用相当于2.5mg或更高剂量的泼尼松3个月或更长时间，应评估其骨折风险。中度或高度风险的患者应开始双膦酸盐治疗，或如果有禁忌，则使用二线药物，如特立帕鲁肽或狄诺塞单抗。
To summarize monitoring, prevention, and treatment options of glucocorticoid-induced osteoporosis for patients on chronic glucocorticoid therapy. Recent meta-analyses highlight the efficacy of bisphosphonate use in improving bone mineral density and in reducing vertebral fractures in the setting of long term glucocorticoid use. A new study has now shown that alendronate also reduces the risk of hip fracture in glucocorticoid use. Emerging data indicate that teriparatide and denosumab also reduce the risk of osteoporotic fracture in glucocorticoid-induced osteoporosis. Glucocorticoid use is a leading cause of secondary osteoporosis; however, patients at risk of glucocorticoid-induced osteoporosis are often not evaluated or treated in a timely manner. Patients on a dose equivalent of 2.5mg prednisone or greater for 3 months or longer duration should have their fracture risk assessed. Those at moderate or high risk should start bisphosphonate therapy, or if contraindicated, a second line agent such as teriparatide or denosumab.