Management of Glucocorticoid-Induced Osteoporosis
Management of Glucocorticoid-Induced Osteoporosis
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DOI：
10.1007/s00223-012-9630-5
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发表时间：
2012-10-01
影响因子：
4.2
通讯作者：
Reginster, J. Y.
中科院分区：
文献类型：
--
作者：
Rizzoli, R.;Adachi, J. D.;Reginster, J. Y.
本综述总结了现有的循证数据，这些数据构成了治疗干预的基础，并涵盖了糖皮质激素诱导的骨质疏松症（GIOP）管理的现状、监管要求和风险评估选项。已知糖皮质激素会导致骨丢失和骨折，但许多接受或开始糖皮质激素治疗的患者没有得到适当的评估和治疗。欧洲骨质疏松症和骨关节炎临床和经济问题学会召开了一次研讨会，讨论GIOP管理问题，并由一个专家小组提供一份报告。一个专家小组审查了讨论批准的治疗药物的现有研究，重点是报告骨矿物质密度和/或骨折风险的随机和对照临床试验，持续时间至少48周。没有证据表明GIOP和绝经后骨质疏松症对治疗的反应不同。FRAX算法可根据糖皮质激素剂量进行调整。现有的抗肿瘤治疗，如双膦酸盐和特立哌齐在GIOP管理中是有效的。其他几种被批准用于治疗绝经后骨质疏松症的药物也可能用于GIOP。建议在糖皮质激素停止后停止抗肿瘤治疗，除非患者骨折风险仍然增加。钙和维生素D补充剂作为一种预防糖尿病的措施不如特异性抗糖尿病治疗有效。骨折终点研究和调查特定亚群（儿童、绝经前或老年患者）的其他研究将加强证据基础，并促进干预阈值和治疗指南的制定。
This review summarizes the available evidence-based data that form the basis for therapeutic intervention and covers the current status of glucocorticoid-induced osteoporosis (GIOP) management, regulatory requirements, and risk-assessment options. Glucocorticoids are known to cause bone loss and fractures, yet many patients receiving or initiating glucocorticoid therapy are not appropriately evaluated and treated. An European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis workshop was convened to discuss GIOP management and to provide a report by a panel of experts. An expert panel reviewed the available studies that discussed approved therapeutic agents, focusing on randomized and controlled clinical trials reporting on bone mineral density and/or fracture risk of at least 48 weeks' duration. There is no evidence that GIOP and postmenopausal osteoporosis respond differently to treatments. The FRAX algorithm can be adjusted according to glucocorticoid dose. Available antiosteoporotic therapies such as bisphosphonates and teriparatide are efficacious in GIOP management. Several other agents approved for the treatment of postmenopausal osteoporosis may become available for GIOP. It is advised to stop antiosteoporotic treatment after glucocorticoid cessation, unless the patient remains at increased risk of fracture. Calcium and vitamin D supplementation as an osteoporosis-prevention measure is less effective than specific antiosteoporotic treatment. Fracture end-point studies and additional studies investigating specific subpopulations (pediatric, premenopausal, or elderly patients) would strengthen the evidence base and facilitate the development of intervention thresholds and treatment guidelines.