类固醇诱发的骨质疏松课件.pptVIP

Corticosteroid - Induced Osteoporosis 2012 Osteoporosis Systemic skeletal disease Low bone mass Microarchitectural deterioration of bone tissue Increase in bone fragility and fracture susceptibility 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 Corticosteroid-Induced Osteoporosis Common, iatrogenic form of secondary osteoporosis Associated with corticosteroid use in chronic, noninfectious medical conditions Asthma - Nephrotic syndrome Chronic lung disease - Transplantation Rheumatologic disorders - etc Inflammatory bowel disease Clinical significant - Increase bone loss and fracture : 6 Mo. - Trabecular cortical bone - 7.5 mg of prednisolone ( equivalent ) - Incidence of osteoporosis ~ 30-50% - Vertebral fracture 30-35 % , hip fracture 50% - Rate of bone loss 2-4 % per year - Alternate day regimen , inhale steroids Fracture Risk and Dose of Corticosteroids CIO in Patients With Asthma CIO in Patients With Rheumatoid Arthritis CIO and Systemic Lupus Erythematosus Potential Factors Causing Bone Loss in Inflammatory Bowel Disease Corticosteroids Vitamin D / Calcium deficiency Poor nutritional status Inflammation Physical inactivity Concurrent medications (immunosuppressive agents) CIO and Chronic Obstructive Pulmonary Disease 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 Calcium homeostasis Gonadal hormone Inhibit bone formation Increase bone resorption other Calcium homeostasis Decreas