糖皮质激素性骨质疏松致病机制最新研究进展

Recent advances in the glucocorticoid-induced osteoporosis

糖皮质激素（glucocorticoid,GC）在临床医疗中广泛被使用,主要表现其在免疫抑制、抗炎症反应、抗休克、解除支气管痉挛哮喘等疾病的药理学作用[1]。长期或者高剂量使用GC会导致一些不良反应,如：肌肉骨组织紊乱,如骨质疏松症、骨坏死、肌病、肌肉减少症等以及代谢作用导致的葡萄糖耐受不良、糖尿病、血脂异常、脂肪异常增长等疾病[2]。这些副作用已经成为临床治疗棘手的问题。

Glucocorticoid is widely used in anti-inflammatory and immune-modulatory drugs while its related side effects shouldn＇t allow to be neglected, such as osteoporosis, diabetes, and obesity. Clinical applications of it has also been greatly restricted. Improvement of results of these unnecessary outcomes also become the main challenge of medical work. To explore the pathogenetic mechanisms of glucocorticoid-induced osteoporosis（ GIO） and its effects on bone and mineral metabolism are of crucial importance. Endogenous glucocorticoid of physiological-concentration is not only a key regulating factor for differentiation of mesenchymal stem cells and bone development, but also involved in regulating calcium handling by kidney and gastrointestinal tract. As supra-physiological concentration, it acts as a ＂double-edged sword＂ role, taking unfavorable effect in the same tissue. Over the years there has been a controversial paradox about GIO mechanism for the anabolic and catabolism of glucocorticoid, which needs to be further in-depth studied. This paper reviews highlighted recent advances on physiology and pathology of glucocorticoid for bone metabolism, and to provide new strategies for prophylaxis and treatment of GIO.