High-dose glucocorticoid treatment induces rapid loss of trabecular bone mineral density and lean body mass
High-dose glucocorticoid treatment induces rapid loss of trabecular bone mineral density and lean body mass
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DOI：
10.1007/s00198-005-1923-3
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发表时间：
2006-01-01
影响因子：
4
通讯作者：
Nakao, K
中科院分区：
文献类型：
--
作者：
Natsui, K;Tanaka, K;Nakao, K
最近的一项大规模研究表明，糖皮质激素治疗增加了骨折的风险，其发生的剂量和持续时间比以前认为的要小得多。为了研究骨折风险增加的潜在机制，我们通过双能X线吸收测定法（DXA）研究了开始大剂量糖皮质激素治疗后骨矿物质密度（BMD）和身体成分的早期变化。高剂量糖皮质激素治疗被任意定义为每日剂量>= 40 mg泼尼松龙当量。入组本研究的33例患者之前未接受过糖皮质激素治疗。仅2个月的治疗就导致了大量的BMD损失，最明显的是腰椎，其次是股骨颈和全身，这表明优先的小梁骨损失。身体成分也受到很大影响。因此，2个月的糖皮质激素治疗显着降低骨矿物质含量（BMC），瘦体重（LBM）和增加脂肪量（FAT）。我们的研究结果可能具有一定的临床意义。首先，在开始糖皮质激素治疗后，BMD损失发生得相当快，接受糖皮质激素治疗的患者应更仔细地监测其BMD。其次，LBM，主要代表肌肉体积，在开始糖皮质激素治疗后迅速下降。LBM减少也可能是骨折风险增加的原因，因为跌倒是骨折的一个众所周知的风险因素，接受糖皮质激素治疗的患者也应评估其身体成分。
A recent large-scale study revealed that glucocorticoid treatment increased fracture risk, which occurred at a far smaller dose and by a shorter duration than previously thought. To study the underlying mechanism for the increased risk of fracture, we studied the early changes in bone mineral density (BMD) and body composition by dual energy X-ray absorptiometry (DXA) after initiating high-dose glucocorticoid treatment. High-dose glucocorticoid treatment was arbitrarily defined as daily doses of >= 40 mg of a predonisolone equivalent. The 33 patients enrolled in this study had not received glucocorticoid treatment before. Only 2 months of treatment resulted in substantial BMD loss, most markedly in the lumbar spine, followed by the femoral neck and total body, which suggests the preferential trabecular bone loss. Body composition was also greatly affected. Thus, 2-month treatment with glucocorticoid significantly reduced bone mineral content (BMC), lean body mass (LBM) and increased fat mass (FAT). Our results are likely to have some clinical relevance. First, BMD loss occurs quite rapidly after starting glucocorticoid treatment, and patients receiving glucocorticoid treatment should be more carefully monitored for their BMD. Second, LBM, which mainly represents muscle volume, decreases rapidly after initiating glucocorticoid treatment. Decreased LBM might be also responsible for the increased risk of fracture, since falling is a well-known risk factor for fracture, and patients receiving glucocorticoid treatment should also be evaluated for their body composition.