糖皮质激素性骨质疏松症的研究进展

The investigation of glucocorticoid induced osteoporosis

糖皮质激素应用范围广泛且往往长期使用,它的主要副作用就是导致骨质疏松症并增加骨折风险。并非大剂量应用糖皮质激素才会导致骨质疏松。老年人及开始糖皮质激素治疗之前即存在骨矿密度低的患者,骨量丢失更加明显,更易导致骨折的发生。除了应用糖皮质激素以外,还有很多因素会导致骨量丢失,如：基础疾病、营养不良、维生素D缺乏、性腺发育不全及低体重等。本综述说明了糖皮质激素性骨质疏松症的发病率、高危人群、发病机制以及如何对其进行预防和治疗。目前预防糖皮质激素性骨质疏松症主要依赖于钙剂和维生素D的补充,充足的蛋白质摄取,定期的体育锻炼。一些新的治疗方法如双膦酸盐和甲状旁腺素的应用给糖皮质激素性骨质疏松症的治疗带来了希望。尽管我们的治疗和预防策略已有长足进步,我们还需要对它进行进一步的补充。

Glucocorticoids are widely used, often long term, and a major side effect is osteoporosis and increased risk of fracture. Glucoeorticoid-induced osteoporosis is an increasing problem that occurs not only in those on highdose therapy. Elderly patients with low bone densities before the initiation of glueocortieoid therapy are at particular risk of developing significant bone loss that could result in fractures. Many factors contribute to bone loss during glueocorticoid therapy, such as underlying disease, malnutrition, vitamin D insufficiency, hypogonadism, and low body weight. This review considers how common is the problem, the patients who are most at risk, our current understanding of mechanisms, and how to prevent and effectively treat glueoeorticoid-induced osteoporosis. Prevention of glucoeorticoid-indueed osteoporosis is based on genera/ measures such as calcium and vitamin D supplementation, adequate protein intake, regular physical exercise. New therapies with anti-resorptive agents such as bisphosphonates and with anabolic agents such as parathyroid hormone offer the prospect of effective treatment of glucoeorticoid-indueed osteoporosis. Although our understanding of effective prevention and treatment strategies is improving, there needs to be better implementation of these strategies.