GCinducedosteoporosis风湿免疫科课件.ppt

GCinducedosteoporosis风湿免疫科;Introduction;OP in RA on GC Rx;Pathophysiology;GC receptor binding;Effects of GC on bone metabolism;? Bone formation;Effects of GC on bone metabolism;Epidemiology;Factors associated with fracture risk with GC Rx;Relative Risk of Fracture;Risk factors for bone loss fracture;Bone Density Fracture Risk;Dose, duration formulation of Rx Bone Loss;Investigations;Treatment of GC OP;Prevention of GC-induced bone loss;Drug Rx;Calcium;Vitamin D active - metabolites;HRT;Bisphosphonates;Alendronate;;Risedronate;PTH;Calcitonin;Thiazide diuretics salt restriction;GIOP干预措施实施时机;GIOP--ACR Guideline(1); long-term GC (equivalent of 5 mg/day):??? 纠正对OP不良的生活习惯 停止或少吸烟??? ??减少过度饮酒 负重体育锻炼指导? 开始补钙? 开始补充VitD (plain or activated form).? 如缺乏或有临床指征---HRT??? 测定腰椎和/或髋关节BMD.?? ? If BMD abnormal (i.e., T-score below -1)－－BPT (绝经期前妇女使用小心).?? ? BPT有禁忌或不能耐受－－calcitonin ?If BMD is normal－－随诊，每年或每两年复查BMD. ;Guideline－－英国（Bone and Tooth Society of Great Britain, the National Osteoporosis Society and the Royal College of Physicians）;Guideline－－英国（Bone and Tooth Society of Great Britain, the National Osteoporosis Society and the Royal College of Physicians）;Guideline－－英国（Bone and Tooth Society of Great Britain, the National Osteoporosis Society and the Royal College of Physicians） ;Drug Rx;Guideline－－英国（Bone and Tooth Society of Great Britain, the National Osteoporosis Society and the Royal College of Physicians） ;GIOP--Belgium Guideline;GIOP--Belgium Guideline Ca and VitD;GIOP--Belgium Guideline Ca and VitD;系统性红斑狼疮的骨质疏松与皮质激素的相关性;研究对象;骨质疏松的诊断按世界卫生组织1994年提出的标准：（1）骨密度值低于正常年轻人峰值2.5个标准差（s）为骨质疏松；（2）骨密度值在正常年轻人峰值以下1.0～2.5 s 之间为骨量减少。;方法;;;表1　激素疗程对骨密度的影响( ±s);;