Glucocorticoid-induced osteoporosis.
Glucocorticoid-induced osteoporosis.
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DOI：
10.1136/rmdopen-2014-000014
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发表时间：
2015
期刊：
影响因子：
6.2
通讯作者：
Roux C
中科院分区：
文献类型：
--
作者：
Briot K;Roux C
皮质类固醇诱发的骨质疏松症是继发性骨质疏松症最常见的形式，也是年轻人的第一病因。骨丢失和骨折发生率增加发生在激素治疗开始后的早期，然后与剂量和治疗时间有关。骨折风险的增加不能通过骨密度测量来完全评估，因为它还与骨骼质量的改变和跌倒风险的增加有关。在类风湿性关节炎患者中，注重低疾病活动性的靶向治疗策略，包括使用小剂量强的松，是预防骨丢失的关键决定因素。骨丢失的程度是可变的，并且没有明确识别的个体骨折风险的预测因素。所有接受强的松治疗的患者都应考虑预防或治疗骨质疏松症。双膦酸盐和合成代谢剂甲状旁腺激素(1-34)在治疗皮质类固醇引起的骨质疏松症方面显示出了它们的有效性。最近的国际指南是可用的，应该指导皮质类固醇引起的骨质疏松症的治疗，这种骨质疏松症仍然没有得到充分的诊断和治疗。抗骨质疏松治疗的持续时间应该在个体水平上进行讨论，这取决于受试者的特征和潜在的炎症演变。
Corticosteroid-induced osteoporosis is the most common form of secondary osteoporosis and the first cause in young people. Bone loss and increased rate of fractures occur early after the initiation of corticosteroid therapy, and are then related to dosage and treatment duration. The increase in fracture risk is not fully assessed by bone mineral density measurements, as it is also related to alteration of bone quality and increased risk of falls. In patients with rheumatoid arthritis, a treat-to-target strategy focusing on low disease activity including through the use of low dose of prednisone, is a key determinant of bone loss prevention. Bone loss magnitude is variable and there is no clearly identified predictor of the individual risk of fracture. Prevention or treatment of osteoporosis should be considered in all patients who receive prednisone. Bisphosphonates and the anabolic agent parathyroid hormone (1–34) have shown their efficacy in the treatment of corticosteroid-induced osteoporosis. Recent international guidelines are available and should guide management of corticosteroid-induced osteoporosis, which remains under-diagnosed and under-treated. Duration of antiosteoporotic treatment should be discussed at the individual level, depending on the subject's characteristics and on the underlying inflammation evolution.