课件：系统性红斑狼疮的骨质疏松与皮质激素的相关性.ppt

纳入本研究的SLE患者有一定选择性，即年龄≤45岁、肾功能正常、非卧床不起而有一定体力活动者。 这样排除了某些可能造成骨质疏松的可预见的危险因素后，经DXA及骨超声检查有48.9%及42.3%服用激素的SLE患者出现骨量减少和骨质疏松。 激素造成的骨量丢失主要发生在松质骨，因此Ward三角的骨质疏松最为多见。 本研究证实SLE患者骨质疏松的发生与应用激素的疗程和累积量相关。当激素累积量30g时最常见的骨质疏松部位为L2～L4及Ward三角。 THANK YOU SUCCESS * * 可编辑 Drug Rx Beneficial effects in spine hip demonstrated in spine hip by several interventions Post hoc/ safety analysis of trials of etidronate, alendronate residronate ? ? vertebral fractures Calcium GC ? ? intestinal calcium absorbtion ? urinary calcium excretion Conflicting data on efficacy in primary prevention ACR : Calcium intake (diet/ suppl) 1000 – 1500 mg/d Vitamin D active - metabolites Calcitriol (1,25 dihydroxy vitamin D) Alfacalcidiol (1? vitamin D) 1o prevention : ? BMD vs placebo 2o prevention : active vit D metabolites better than simple vit D ? BMD/ ? fracture/ ? pain Risk : hypercalcaemia hypercalcuria HRT 1 controlled trial in men ? BMD with testosterone vs calcium 1 randomised control trial in postmenopausal women ? BMD with oestrogen vs calcium No trials in premenopausal women No fracture data Reserved for pts with hormone deficiency Bisphosphonates ? bone resorbtion May ? GC induced apoptosis of osteoblasts Alendronate Combined analysis of trials (477 pts) ? vertebral/ femoral neck/ trochanter whole body BMD Post hoc analysis of vertebral fractures favoured Alendronate in postmenopausal women Risedronate Primary prevention trial (224 pts) Placebo + calcium vs Risedronate After 1 yr, BMD on Risedronate unchanged but ? with placebo Incidence of vertebral fractures 17% with calcium vs 5.7% with Risedronate 5mg (p=0.072) Vertebral fractures seen only in postmenopausal women men, not premenopausal women Study of 290 pts ? L spine femoral neck BMD vs Ca + Vit D Not powered to show fracture efficacy Vertebral fractures: 15% controls; 5% Risedronate Suggested 70% ? fracture risk PTH ? lifespan on osteoclasts osteoblasts ? ? osteoblast no. ? BMD in postmenopausal