Effects of inhaled glucocorticoids on bone density in premenopausal women.
Effects of inhaled glucocorticoids on bone density in premenopausal women.
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DOI：
10.1056/nejmoa002304
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发表时间：
2001-09-27
影响因子：
158.5
通讯作者：
LeBoff, MS
中科院分区：
文献类型：
--
作者：
Israel, E;Banerjee, TR;LeBoff, MS
背景：吸入性糖皮质激素是哮喘患者长期治疗中最常用的药物。长期吸入糖皮质激素治疗是否会像口服糖皮质激素治疗那样减少骨量，这是有争议的。在一项为期三年的前瞻性研究中，我们研究了绝经前哮喘妇女吸入糖皮质激素的剂量与骨质损失率之间的关系。方法：我们研究了109名绝经前妇女，年龄在18至45岁之间，她们患有哮喘，没有已知的导致骨质流失的疾病，并接受吸入曲安奈德（每吸100 μ g）治疗。我们通过双光子吸收仪在基线、六个月、一、两年和三年测量骨密度。连续测定血清骨钙素、甲状旁腺激素、尿n -末端肽、皮质醇和钙排泄。我们通过每月日记的方式测量吸入糖皮质激素的使用，并使用自动执行器监测装置。结果：吸入性糖皮质激素治疗与全髋关节和粗隆骨密度的剂量相关下降有关，每吸一次每年治疗0.00044 g /平方厘米（P=0.01和P=0.005）。股骨颈或脊柱未见剂量相关效应。即使排除了所有在研究期间接受过口服或静脉注射糖皮质激素的女性，骨密度的下降与每年使用糖皮质激素的次数仍然存在关联。血清和尿液中骨转换或肾上腺功能的标志物不能预测骨质流失的程度。结论：吸入糖皮质激素可导致绝经前妇女髋部骨质的剂量相关性损失。[J] .中华医学杂志，2001;35(5):941- 947。版权所有(C) 2001马萨诸塞州医学协会。
Background: Inhaled glucocorticoids are the most commonly used medications for the long-term treatment of patients with asthma. Whether long-term therapy with inhaled glucocorticoids reduces bone mass, as oral glucocorticoid therapy does, is controversial. In a three-year prospective study, we examined the relation between the dose of inhaled glucocorticoids and the rate of bone loss in premenopausal women with asthma.Methods: We studied 109 premenopausal women, 18 to 45 years of age, who had asthma and no known conditions that cause bone loss and who were treated with inhaled triamcinolone acetonide (100 mu-g per puff). We measured bone density by dual-photon absorptiometry at base line, at six months, and at one, two, and three years. Serum osteocalcin and parathyroid hormone and urinary N-telopeptide, cortisol, and calcium excretion were measured serially. We measured inhaled glucocorticoid use by means of monthly diaries, supported by the use of an automated actuator-monitoring device.Results: Inhaled glucocorticoid therapy was associated with a dose-related decline in bone density at both the total hip and the trochanter of 0.00044 g per square centimeter per puff per year of treatment (P=0.01 and P=0.005, respectively). No dose-related effect was noted at the femoral neck or the spine. Even after the exclusion of all women who received oral or parenteral glucocorticoids at any time during the study, there was still an association between the decline in bone density and the number of puffs per year of use. Serum and urinary markers of bone turnover or adrenal function did not predict the degree of bone loss.Conclusions: Inhaled glucocorticoids lead to a dose-related loss of bone at the hip in premenopausal women. (N Engl J Med 2001;345:941-7.) Copyright (C) 2001 Massachusetts Medical Society.