20xx年醫(yī)學(xué)專題—類固醇誘發(fā)的骨質(zhì)疏松-資料下載頁
2025-11-04 23:52本頁面
【正文】 her thereapy if bone loss if continues Reassessment thereafter if glucocorticoids continue 1. Repeat annual assessment as above 2. Change therapy as needed 3. Consider newer drugs as they become available,第四十三頁，共四十九頁。,ACR Task Force on Osteoporosis: Initiating LongTerm Corticosteroid Therapy,Initial history amp。 physical, lab/DXA measurements Calcium/vitamin D supplementation Patient education,T score 1 Initiate HRT。 bisphosphonates or calcitonin if HRT contraindicated,T score 1 Monitor regularly,One month followup: Obtain 24h urine to measure calcium If 300 mg/d: add thiazide diuretic Adjust dosage of calcium and vitamin D supplementation,612 months followup: Repeat BMD Decrease 5%: change/add medication Increase, no change, or decrease 5%: no change in therapy,American College of Rheumatology Task Force on Osteoporosis Guidelines, 1996.,第四十四頁，共四十九頁。,Anticipated therapy with glucocorticoid Atraumatic fractures Yes No Calcium 1500 mg/day yes Measurement of bone mineral density Vitamin D 400800 IU/day Lower than 2SD below the mean for Exercise 5 % young adults or Lower than 1 SD below the Screen for hypogonadism bone loss mean for agedmatch controls No If hypogonadism present : Calcium 1000 mg/day Add hormone replacement with Vitamin D 400800 IU/day Estrogen in woman and testosterone in men Exercise Check BMD in one year : add antiresorptive Repeat bone mineral density in 1 yr. Therapy if 2 percent bone loss If hypogonadism absent: 5 % bone loss Add bisphosphanate if no fracture pain Add calcitonin if fracture pain Continue conservative therapy as long as bone density criteria above not met,,第四十五頁，共四十九頁。,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，共四十九頁。,CorticosteroidInduced Osteoporosis: Conclusions,Primary treatment goals Reduce fracture risk Maintain or increase bone mass Vitamin D and calcium may slow early resorptive changes HRT is recommended for patients with T scores 1 to prevent bone resorption (use bisphosphonates or calcitonin if HRT is contraindicated) Bisphosphonates are an efficacious treatment Inhibit bone resorption Maintain or increase bone mass Advanced generation bisphosphonates Increase BMD of hip, spine, and total body May lower risk for vertebral, hip, and forearm fractures,第四十七頁，共四十九頁。,Love you with all my fractured bones.,I will always.,第四十八頁，共四十九頁。,內(nèi)容(n232。ir243。ng)總結(jié),Corticosteroid Induced Osteoporosis。r=0.39 (P=0.009)。Osteoclast apoptosis Bone resorption。Vitamin D 18 +1.96。Calcitonin 11 +2.11。Bisphosphonates 18 +5.31?。No,第四十九頁，共四十九頁。,
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