糖皮质激素性骨松进展(英文).ppt

Corticosteroid-Induced OsteoporosisRecent Clinical Advances Osteoporosis Systemic skeletal disease Low bone mass Microarchitectural deterioration of bone tissue Increase in bone fragility and fracture susceptibility Corticosteroid-Induced Osteoporosis Common, iatrogenic form of secondary osteoporosis Associated with corticosteroid use in chronic, noninfectious medical conditions Asthma Chronic lung disease Rheumatologic disorders Inflammatory bowel disease Clinical Burden of CIO Most common form of drug-related osteoporosis in men and women Occurs at any age, in both genders, across races Up to 50% of patients on chronic steroid therapy sustain osteoporotic fractures and/or develop osteonecrosis Pathophysiology of CIO: Overview Bone remodeling occurs throughout adulthood Osteoporosis results from an imbalance between osteoclast and osteoblast activity Two metabolic abnormalities contribute to increased bone resorption Secondary hyperparathyroidism due to decreased GI absorption and urinary excretion of calcium Altered gonadal function and decreased adrenal production of androgens Pathophysiology of CIO: Bone Formation and Resorption Fracture Risk and Dose of Corticosteroids Diagnosis of CIO: Initial Clinical Work-Up Medical history Risk factors for bone loss Physical exam Clinical signs and symptoms Diagnosis of CIO: Biochemical Assessment Complete blood cell count Serum creatinine Serum calcium Serum alkaline phosphatase Serum free testosterone in males Estradiol in premenopausal women Serum levels of liver enzyme Serum phosphorus Serum 25-hydroxyvitamin D 24-hour urinary calcium and sodium Serum electrolytes Serum albumin Diagnosis of CIO: Bone Density Assessment WHO Criteria for Assessing Disease Severity Guidelines for BMD Measurement Baseline BMD prior to/within 6 months of initiating therapy Antero-posterior measurement of lumbar spine and femoral neck Follow-up at 6 and 12 months, annually thereafter until bone mass stabilizes Measuring hip alone may m