新指南-新启示.pptxVIP

新指南，新启示糖皮质激素引起的骨质疏松（GIOP）糖皮质激素是继发性骨质疏松症的首要原因女性骨质疏松发病原因 男性骨质疏松发病原因其它原因肿瘤嗜酒原发性口服类固醇激素性腺功能低下GC是继发性骨质疏松症的首要原因，GIOP在所有骨质疏松中占第三位，仅次于绝经后骨质疏松和老年性骨质疏松HANSEN L B, VONDRACEK S F. Prevention and treatment ofnonpostmenopausal osteoporosis[ J]. Am J Health Syst Pharm,2004, 61(24): 2637-2654.80年前已认识到糖皮质激素与骨丢失的关系1932年，美国神经外科医生Harvey Cushing首次描述了内源性皮质醇增多症导致的骨密度降低和骨折1954年（强的松开始用于类风湿性关节炎仅几年），研究人员报道了外源性糖皮质激素对骨骼的不良影响 Cushing H. Bull Johns Hopkins Hosp 1932, 50:137–95. Curtis PH, et al. JAMA 1954, 156:467–9. 进入新世纪，GIOP成为各国的关注重点中华医学会骨质疏松和骨矿盐疾病分会《糖皮质激素性骨质疏松症诊治指南》（2006）American College of Rheumatology ad hoc Committee on Glucocorticoid-induced Osteoporosis (2001) Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 updateRoyal College of Physicians (2002) Glucocorticoid-induced osteoporosis. Guidelines on prevention and treatment. Bone and Tooth Society of Great Britain, National Osteoporosis Society and Royal College of PhysiciansScientific Advisory Council of the Osteoporosis Society of Canada (2002) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. (2006) Evidence-based guidelines for the prevention and treatment of glucocorticoidinduced osteoporosis: a consensus document of the Belgian Bone Club. (2006) Review and evaluation of the Dutch guidelines for osteoporosis(2007) EULAR evidencebased recommendations on the management of systemic glucocorticoid therapy in rheumatic diseasesSubcommittee to Study Diagnostic Criteria for Glucocorticoid-Induced Osteoporosis (2005) Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research(2004).2010-2012年两项新的GIOP指南发布JENNIFER M. GROSSMAN, et al. Arthritis Care Research,2010;62(11):1515-1526S. Lekamwasam, et al. Osteoporos Int, published online 21 March 2012今天的内容PART 1：糖皮质激素引起骨改变的病理机制PART 2：GIOP新指南解读糖皮质激素治疗导致骨量流失10mg/天1020mg/天20mg/天12多项纵向研究显示：糖皮质激素在治疗数星期后骨量开始流