课件：糖皮质激素性骨质疏松症.ppt

THANK YOU SUCCESS * * 可编辑 在继发性骨质疏松症中最危险的因素就是恶性肿瘤，最常见的原因就是糖皮质激素的使用。 所有服用糖皮质激素患者，不论年龄,性别,种族都是易感人群。 美国总人口的0.2%～0.5%使用糖皮质激素，超过5%的使用糖皮质激素的人出现骨量丢失或者骨折，骨量丢失的程度与糖皮质激素的剂量和持续时间相关。 在英国用的最多的也是呼吸道的疾病。 1.与成骨细胞表面糖皮质激素受体结合（减少功能与寿命，促进凋亡，干扰分化，破坏成骨细胞前体细胞的形成） 2.成熟的破骨细胞缺乏糖皮质激素受体，延长寿命. 3.抑制IGF-1对骨形成的刺激作用.转化生长因子?（TGF－ ? ）(前成骨细胞分化，胶原合成，骨基质沉积) 4.有研究显示大多数GIOP患者PTH并不升高。 5.雌激素作用于成骨细胞表面受体抑制骨吸收，通过降钙素抑制骨吸收。糖皮质激素降低雌激素睾酮水平。 1.骨丢失易发生在脊柱的骨小梁，对松质骨影响大于皮质骨，所以椎骨骨折风险更高。 2. 。 * 口服激素骨密度下降多在3个月，6个月达高峰，在糖皮质激素使用的头一年骨量丢失非常迅速，可以达到12～20%，随后每年丢失3%；对松质骨的影响大于皮质骨。 使用激素无最小安全剂量。7.5mg/d 2.5mg/d 1.骨丢失程度与使用剂量及疗程有关。 * Glucocorticoid (GC)-induced osteoporosis mostly affects trabecular bone of vertebrae. Only 30% of vertebral fractures are symptomatic, yet both clinical and radiological vertebral fractures have been associated with increased mortality and morbidity. The aims of this cross-sectional,outpatient-based study were to measure the prevalence of asymptomatic vertebral fractures in a large sample of post-menopausal women given GCs for different diseases; to compare prevalence of asymptomatic vertebral fractures according to disease, GC treatment and major risk factors;and to assess the quality of life in GC users with and without asymptomatic vertebral fractures. 551 patients referring to 39 centers as outpatients for their programmed follow-up and satisfying the inclusion criteria were included in the analysis. Each patient underwent structured medical interview (including dose and duration of GC therapy, major risk factors for osteoporosis, the quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO) and a back function score questionnaire), thoraco-lumbar radiographs and subsequent morphometry;for 253 and 437 patients, respectively, lumbar spine bone mineral density (BMD) assessed by dual energy X-ray absorptiometry and calcaneal bone stiffness assessed by quantitative ultrasonometry were available. The prevalence of asymptomatic vertebral fractures resulted 37%, with 14% of