20xx年醫(yī)學(xué)專題—類固醇誘發(fā)的骨質(zhì)疏松-預(yù)覽頁(yè)
【正文】 。,Fracture Risk and Dose of Corticosteroids,Relative risk of fracture by dosages of corticosteroids of prednisolone. van Staa TP, et al, 1998.,0,1,2,3,4,5,6,2.5 mg/d,2.57.5 mg/d,7.5 mg/d,Relative risk of fracture,compared with control,Hip fracture,Vertebral fracture,第六頁(yè)，共四十九頁(yè)。 therapy = 7 mg prednisone equivalent per day. Density change measured as change in absolute or Z score (difference in standard deviation compared with healthy agematched controls of the same race and sex) compared to baseline. Verhoeven AC, et al, 1997.,第八頁(yè)，共四十九頁(yè)。,CIO and Chronic Obstructive Pulmonary Disease,*P0.05 vs. ISU or NSU。,Calcium homeostasis,Decrease calcium and phosphate from GI tracts unknown mechanism Increase urinary calcium excretion decrease calcium reabsorption at distal tubules Stimulatiom PTH secretion,第十四頁(yè)，共四十九頁(yè)。,Osteoclast increase osteoclast activity increase apoptosis of mature osteoclast,Bone formation and bone resorption,第十七頁(yè)，共四十九頁(yè)。,Patient Evaluation,Physical examination Evidence of osteoporosis : evidence of fracture , kyphosis , loss of height , muscle strength and size General physical findings : assessment of underlying disorder , other medical conditions,第二十一頁(yè)，共四十九頁(yè)。,Guidelines for BMD Measurement,Baseline BMD prior to/within 6 months of initiating therapy Anteroposterior measurement of lumbar spine and femoral neck Followup at 6 and 12 months, annually thereafter until bone mass stabilizes Measuring hip alone may miss more rapid loss in spine,第二十四頁(yè)，共四十九頁(yè)。,Pharmacologic Treatment of CIO: Overview,第二十七頁(yè)，共四十九頁(yè)。 P=0.027 between groups 1 and 2. Lukert BP, et al, 1992.,*,第三十頁(yè)，共四十九頁(yè)。,0,2,4,6,Lumbar spine*,Femoral neck,Trochanter,Change in BMD from baseline (%),Men,Premenopausal women,Postmenopausal women,Etidronate: Pooled Results from Three Randomized Trials,*P0.05 betweengroup difference. Roux C, et al,1998.,第三十三頁(yè)，共四十九頁(yè)。 ?P 0.001 vs. baseline, ?P 0.01 vs. baseline。 ?P0.05 vs. control. Saag KG, et al, 1998.,*,*,**,**,?,?,4,3,2,1,0,1,2,3,4,Lumbar spine,Femoral neck,Trochanter,Change in BMD from baseline (%),Control,Alendronate 10 mg,Alendronate 5 mg,Alendronate 2.5 mg year 1, 10 mg year 2,第三十六頁(yè)，共四十九頁(yè)。,Treatment Number of Change in lumbar pooled trials spine BMD (%)* Vitamin D 18 +1.96 Calcitonin 11 +2.11 Bisphosphonates 18 +5.31?,Bisphosphonates in the Management of CIO: A MetaAnalysis,*Compared with no treatment or with calcium alone ?P=0.0001 compared with calcitonin or vitamin D,第四十頁(yè)，共四十九頁(yè)。,ACR Task Force on Osteoporosis: Initiating LongTerm Corticosteroid Therapy,Initial history amp。,CorticosteroidInduced Osteoporosis: Conclusions,Most common form of drugrelated osteoporosis Imbalance in bone formation and resorption Resultant bone loss and fracture Bone densitometry is recommended for all patients on chronic steroid therapy T scores ? 2.5 indicate osteoporosis T scores ? 1 indicate osteopenia Each standard deviation change in bone density is associated with at least a twofold change in fracture risk,第四十六頁(yè)，共四十九頁(yè)。ir243。Vitamin D 18 +1.
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