糖皮质激素导致骨质疏松:效果和管理的更新
译者:刘樱 校对者:庞宇洁 审阅者:张莉芸
Glucocorticoid-induced osteoporosis: An update on effects and management.
Abstract Glucocorticoids remain a cornerstone of guideline--d management of persistent asthma and allergic diseases.Glucocorticoid-induced osteoporosis (GIO) is the most common iatrogenic cause of secondary osteoporosis and an issue of concern for physicians treating patients with inhaled or oral glucocorticoids either continuously or intermittentlyPatients with GIO experience fragility fractures at better dual-energy x-ray absorptiometry T-scores than those withpostmenopausal or age-related osteoporosis. This might be explained, at least in part, by the effects of glucocorticoidsnot only on osteoclasts but also on osteoblasts and osteocytes. Effective options to detect and manage GIO exist, and a management algorithm has been published by the American College of Rheumatology to provide treatment guidance for clinicians. This review will summarize GIO epidemiology and pathophysiology and assess the role of inhaled and oralglucocorticoids in asthmatic adults and children, with particular emphasis on the effect of such therapies on bone health. Lastly, we will review the American College of Rheumatology GIO guidelines and discuss diagnostic and therapeutic strategies to mitigate the risk of GIO and fragility fractures.
糖皮质激素是治疗过敏性哮喘疾病的基本用药。激素导致骨质疏松是继发性骨质疏松最常见的原因并且对于无论是间断或长期的吸入或口服激素的内科治疗都成为了一个值得关注的问题。最后,我们将回顾美国风湿病大学对于激素导致骨质疏松的治疗指南及讨论诊断治疗策略从而减少激素导致骨质疏松和脆性骨折的风险。激素诱导性骨质疏松比绝经后或老年导致骨质疏松更易在双能X线中表现脆性骨折。这至少可以解释糖皮质激素不仅对破骨细胞有影响,还对成骨细胞和骨祖细胞有影响。为了有效的管理和减少激素诱导性骨质疏松的出现,一所美国大学的风湿学科发布了一个为临床医生提供治疗指导的管理计算法则。最后,这篇文献将会总结激素导致骨质疏松的流行病学和病理生理学以及对口服或吸入激素的过敏性哮喘患者进行病情评估以及强调这些治疗对于骨质健康的影响。