Management of Glucocorticoid-Induced Osteoporosis

被引：97

作者：

Rizzoli, R. ^{[1
]}

Adachi, J. D. ^{[2
]}

Cooper, C. ^{[3
,4
]}

Dere, W. ^{[5
]}

Devogelaer, J. P. ^{[6
]}

Diez-Perez, A. ^{[7
,8
]}

Kanis, J. A. ^{[9
]}

Laslop, A. ^{[10
]}

Mitlak, B. ^{[11
]}

Papapoulos, S. ^{[12
]}

Ralston, S. ^{[13
]}

Reiter, S. ^{[14
]}

Werhya, G. ^{[15
]}

Reginster, J. Y. ^{[16
]}

机构：

[1] Univ Hosp Geneva, Serv Bone Dis, Fac Med, CH-1211 Geneva 14, Switzerland

[2] McMaster Univ, Div Rheumatol, Dept Med, Hamilton, ON, Canada

[3] Univ Southampton, Southampton Gen Hosp, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England

[4] Univ Oxford, NIHR Musculoskeletal Biomed Res Unit, Inst Musculoskeletal Sci, Oxford, England

[5] Amgen Inc, Uxbridge, Middx, England

[6] Catholic Univ Louvain, Arthrit Unit UCL5390, B-1200 Brussels, Belgium

[7] Univ Autonoma Barcelona, Dept Internal Med, Hosp del Mar, IMIM, E-08193 Barcelona, Spain

[8] Inst Carlos III, RETICEF, Barcelona, Spain

[9] Univ Sheffield, Sch Med, Ctr Metab Bone Dis, WHO Collaborating Ctr, Sheffield, S Yorkshire, England

[10] AGES PharmMed, Vienna, Austria

[11] Eli Lilly & Co, Lilly Res Labs, Indianapolis, IN 46285 USA

[12] Leiden Univ, Med Ctr, Dept Endocrinol & Metab Dis, Leiden, Netherlands

[13] Univ Edinburgh, Sch Mol & Clin Med & Arthrit Res, Mol Med Ctr, Western Gen Hosp, Edinburgh, Midlothian, Scotland

[14] Fed Inst Drugs & Med Devices BfArM, Bonn, Germany

[15] CHU Nancy, Dept Endocrinol, Vandoeuvre Les Nancy, France

[16] CHU Ctr Ville, Head Bone & Cartilage Metab Unit, Liege, Belgium

来源：

CALCIFIED TISSUE INTERNATIONAL | 2012年 / 91卷 / 04期

关键词：

Glucocorticoid; FRAX; Bone therapy; Osteoporosis; Fracture; BONE-MINERAL DENSITY; CORTICOSTEROID-INDUCED OSTEOPOROSIS; VERTEBRAL FRACTURE RISK; METHYLPREDNISOLONE PULSE THERAPY; LOW-DOSE PREDNISONE; DOUBLE-BLIND; ORAL CORTICOSTEROIDS; POSTMENOPAUSAL WOMEN; LONG-TERM; INHALED CORTICOSTEROIDS;

D O I：

10.1007/s00223-012-9630-5

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

This review summarizes the available evidence-based data that form the basis for therapeutic intervention and covers the current status of glucocorticoid-induced osteoporosis (GIOP) management, regulatory requirements, and risk-assessment options. Glucocorticoids are known to cause bone loss and fractures, yet many patients receiving or initiating glucocorticoid therapy are not appropriately evaluated and treated. An European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis workshop was convened to discuss GIOP management and to provide a report by a panel of experts. An expert panel reviewed the available studies that discussed approved therapeutic agents, focusing on randomized and controlled clinical trials reporting on bone mineral density and/or fracture risk of at least 48 weeks' duration. There is no evidence that GIOP and postmenopausal osteoporosis respond differently to treatments. The FRAX algorithm can be adjusted according to glucocorticoid dose. Available antiosteoporotic therapies such as bisphosphonates and teriparatide are efficacious in GIOP management. Several other agents approved for the treatment of postmenopausal osteoporosis may become available for GIOP. It is advised to stop antiosteoporotic treatment after glucocorticoid cessation, unless the patient remains at increased risk of fracture. Calcium and vitamin D supplementation as an osteoporosis-prevention measure is less effective than specific antiosteoporotic treatment. Fracture end-point studies and additional studies investigating specific subpopulations (pediatric, premenopausal, or elderly patients) would strengthen the evidence base and facilitate the development of intervention thresholds and treatment guidelines.

引用

页码：225 / 243

页数：19

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