20xx年醫(yī)學(xué)專題—類固醇誘發(fā)的骨質(zhì)疏松-閱讀頁
2024-11-13 23:52本頁面
【正文】 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，共四十九頁。,Efficacy of Alendronate in Increasing BMD,*P 0.001 vs. control。 ?P 0.001 vs. baseline, ?P 0.01 vs. baseline。,Efficacy of Alendronate: Two Years FollowUp,*P0.001 vs. control。 ?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，共四十九頁。,Effect of Risedronate on BMD in Patients on LongTerm Corticosteroid Therapy,*P0.05 vs. control. Devogelaer JP, et al, 1998.,*,*,*,*,3.0,2.0,1.0,0.0,1.0,2.0,3.0,Lumbar spine,Femoral neck,Trochanter,Change in BMD from baseline (%),at 12 months,Control,Risedronate 2.5 mg,Risedronate 5 mg,第三十八頁，共四十九頁。,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，共四十九頁。,Glucocorticoid therapy evaluation,Reassessment at 23 mo 1. Review glucocorticoid therapy : attempt to decrease or discontinue 2. Assess exercise and calcium intake 3. Measure serum calcium , 24 hr urinary calcium if more than 4 mg/kg/d use hydrochlorothiazide 2550 mg twice daily Reassessment at 6 mo 1. Review glucocorticoid therapy and minimize 2. Assess exercise and calcium intake 3. Repeat serum calcium and 24 hr urinary calcium measurement 4. Alter calcium / vitamin D / thiazide therapy if necessary 5. If pateint is to continue glucocorticoid ,consider to repeat BMD 6. Consider HRT / bisphosphonate/ calcitonin,第四十二頁，共四十九頁。,ACR Task Force on Osteoporosis: Initiating LongTerm Corticosteroid Therapy,Initial history amp。 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。,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。,Love you with all my fractured bones.,I will always.,第四十八頁，共四十九頁。ir243。r=0.39 (P=0.009)。Vitamin D 18 +1.96。Bisphosphonates 18 +5.3
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