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1、Corticosteroid-InducedOsteoporosis2012OsteoporosisSystemicskeletaldiseaseLowbonemassMicroarchitecturaldeteriorationofbonetissueIncreaseinbonefragilityandfracturesusceptibilityClinicalBurdenofCIOMostcommonformofdrug-relatedosteoporosisinmenandwomenOccursatanyage,inbothgen
2、ders,acrossracesUpto50%ofpatientsonchronicsteroidtherapysustainosteoporoticfracturesand/ordeveloposteonecrosisCorticosteroid-InducedOsteoporosisCommon,iatrogenicformofsecondaryosteoporosisAssociatedwithcorticosteroiduseinchronic,noninfectiousmedicalconditionsAsthma-Nephr
3、oticsyndromeChroniclungdisease-TransplantationRheumatologicdisorders-etcInflammatoryboweldiseaseClinicalsignificant-Increasebonelossandfracture:6Mo.-Trabecular>corticalbone-7.5mgofprednisolone(equivalent)-Incidenceofosteoporosis~30-50%-Vertebralfracture30-35%,hipfracture
4、50%-Rateofboneloss2-4%peryear-Alternatedayregimen,inhalesteroidsFractureRiskandDoseofCorticosteroidsRelativeriskoffracturebydosagesofcorticosteroidsofprednisolone.vanStaaTP,etal,1998.01234562.5mg/d2.5-7.5mg/d>7.5mg/dRelativeriskoffracturecomparedwithcontrolHipfractureVer
5、tebralfractureCIOinPatientsWithAsthmaRelationshipofpercentagepredictedbonedensitytodurationofcorticosteroidusein44corticosteroid-treatedasthmaticpatients.SchatzM,DudlJ,ZeigerRS,etal.AllergyProc.1993;14:341-345.Reprintedwithpermission.Percentpredictedbonedensityr=-0.39(P=
6、0.009)Durationofcorticosteroiduse(years)12010080604024681012141618202224262830323436CIOinPatientsWithRheumatoidArthritisCS=corticosteroid;therapy=7mgprednisoneequivalentperday.DensitychangemeasuredaschangeinabsoluteorZscore(differenceinstandarddeviationcomparedwithhealth
7、yage-matchedcontrolsofthesameraceandsex)comparedtobaseline.VerhoevenAC,etal,1997.*P<0.001;**P=0.002.PercentageofSLEpatients(N=97)withlowBMD,asmeasuredbyDXA.KipenY,etal,1997.CIOandSystemicLupusErythematosus******PotentialFactorsCausingBoneLossinInflammatoryBowelDiseaseCor
8、ticosteroidsVitaminD/CalciumdeficiencyPoornutritionalstatusInflammationPhysicalinactivityConcurrentmedi
