糖皮质激素性骨质疏松的研究新进展

The advance in the glucocorticoid-induced osteoporosis

近年来,随着糖皮质激素在临床广泛应用,糖皮质激素性骨质疏松发病率不断上升,在骨质疏松症中其发病率居于第三位,仅次于绝经后骨质疏松及老年性骨质疏松。糖皮质激素除了促进成骨细胞和骨细胞凋亡、降低成骨功能,抑制骨胶原及促进破骨细胞生成并延长其生存时间等直接抑制成骨,还通过调节内分泌及相关细胞因子、抑制骨局部血流量等间接影响骨形成。2008年FRAX工具的推出重新定义了糖皮质激素性骨质疏松风险度,为临床的诊治带来便利。针对其发生脆性骨折的风险,2010年ACR共识对其防治做出了新的调整和推荐,重点强调了双磷酸盐在防治糖皮质激素导致的脆性骨折方面的作用,同时甲状旁腺激素、充足的维生素、钙剂等在有效防治糖皮质性骨质疏松方面也起了重要作用。

Glucocorticoids are widely used in the clinic in recent years.The incidence of glucocorticoid-induced osteoporosis is rising up.It is now the third most frequent cause of secondary osteoporosis besides postmenopausal and senile osteoporosis.The pathological mechanism of glucocorticoid-induced osteoporosis is that glucocorticoids inhibit osteogenesis not only by promoting apoptosis of osteoblast and osteocyte, reducing the collagen and promoting osteoblast formation and prolonging the survival time, but also by regulating endocrine system and related cytokines, reducing blood flow in bone to influence bone formation.In 2008, FRAX was established to redefine the risk probability of glucocorticoid-induced osteoporosis, to facilitate the clinical use.The ACR 2010 consensus suggested the new adoption and recommendation focusing on the risk of fragile fracture.It emphasized the use of bisphosphonates for the prevention and treatment of glucocorticoid-induced osteoporosis.Parathyroid hormone, adequate vitamin and calcium supplement also play an important role in the prevention and treatment of glucocorticoid-induced osteoporosis.