类固醇诱发的骨质疏松优质PPT.ppt

类固醇诱发的骨质疏松优质PPT.ppt

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Corticosteroid-InducedOsteoporosisCorticosteroid-InducedOsteoporosis20122012OsteoporosisSystemicskeletaldiseaseLowbonemassMicroarchitecturaldeteriorationofbonetissueIncreaseinbonefragilityandfracturesusceptibilityClinicalBurdenofCIOMostcommonformofdrug-relatedosteoporosisinmenandwomenOccursatanyage,inbothgenders,acrossracesUpto50%ofpatientsonchronicsteroidtherapysustainosteoporoticfracturesand/ordeveloposteonecrosisCorticosteroid-InducedOsteoporosisCommon,iatrogenicformofsecondaryosteoporosisAssociatedwithcorticosteroiduseinchronic,noninfectiousmedicalconditionsAsthma-NephroticsyndromeChroniclungdisease-TransplantationRheumatologicdisorders-etcInflammatoryboweldiseaseClinicalsignificant-Increasebonelossandfracture:

@#@6Mo.-Trabecularcorticalbone-7.5mgofprednisolone（equivalent）-Incidenceofosteoporosis30-50%-Vertebralfracture30-35%,hipfracture50%-Rateofboneloss2-4%peryear-Alternatedayregimen,inhalesteroidsFractureRiskandDoseofCorticosteroidsRelativeriskoffracturebydosagesofcorticosteroidsofprednisolone.vanStaaTP,etal,1998.01234562.5mg/d2.5-7.5mg/d7.5mg/dRelativeriskoffracturecomparedwithcontrolHipfractureVertebralfractureCIOinPatientsWithAsthmaRelationshipofpercentagepredictedbonedensitytodurationofcorticosteroidusein44corticosteroid-treatedasthmaticpatients.SchatzM,DudlJ,ZeigerRS,etal.AllergyProc.1993;@#@14:

@#@341-345.Reprintedwithpermission.Percentpredictedbonedensityr=-0.39（P=0.009）Durationofcorticosteroiduse（years）12010080604024681012141618202224262830323436CIOinPatientsWithRheumatoidArthritisCS=corticosteroid;@#@therapy=7mgprednisoneequivalentperday.DensitychangemeasuredaschangeinabsoluteorZscore（differenceinstandarddeviationcomparedwithhealthyage-matchedcontrolsofthesameraceandsex）comparedtobaseline.VerhoevenAC,etal,1997.*P0.001;@#@*P=0.002.PercentageofSLEpatients（N=97）withlowBMD,asmeasuredbyDXA.KipenY,etal,1997.CIOandSystemicLupusErythematosus*PotentialFactorsCausingBoneLossinInflammatoryBowelDiseaseCorticosteroidsVitaminD/CalciumdeficiencyPoornutritionalstatusInflammationPhysicalinactivityConcurrentmedications（immunosuppressiveagents）CIOandChronicObstructivePulmonaryDisease*P0.05vs.ISUorNSU;@#@*P0.005vsISU.McEvoyCE,etal,1998.*PathophysiologyofCIO:

@#@OverviewBoneremodelingoccursthroughoutadulthoodOsteoporosisresultsfromanimbalancebetweenosteoclastandosteoblastactivityTwometabolicabnormalitiescontributetoincreasedboneresorptionSecondaryhyperparathyroidismduetodecreasedGIabsorptionandurinaryexcretionofcalciumAlteredgonadalfunctionanddecreasedadrenalproductionofandrogensPathophysiologyofCIOCalciumhomeostasisGonadalhormoneInhibitboneformationIncreaseboneresorptionotherCalciumhomeostasisDecreasecalciumandphosphatefromGItractsunknownmechanismIncreaseurinarycalciumexcretiondecreasecalciumreabsorptionatdistaltubulesStimulatiomPTHsecretionGonadalhormoneeffectsDecreasesexhormone:

@#@direct&@#@indirectDecreaseLHfrompituitarygland:

@#@estrogenandtestosteroneDecreasesynthesisfromadrenalglandsDecreasesexhormonebindingglobulinBoneformationandboneresorptionOsteoblast-inh.Osteoblastproliferation-decreasematrixsynthesis-increaseapoptosis-decreaseproteinsynthesis（type1collagenandnoncollagenousprotein-decreaseosteocalcin,IGF1,IGFBP3,5,insulin-likegrowthfactors,transforminggrowthfactorB,prostaglandinEOsteoclastincreaseosteoclastactivityincreaseapoptosisofmatureosteoclastBoneformationandboneresorptionOsteoblastproliferationApoptosisOBnumberProteinsynthesisBoneformationDifferentiationBonemassFractureRiskAndrogenOsteoclastapoptosisBoneresorptionOsteoclastformationPTHCalciumandphosphateabsorption（gutandkidney）GlucocorticoidDiagnosisofCIO:

@#@InitialClinicalWork-UpMedicalhistoryRiskfactorsforbonelossPhysicalexamClinicalsignsandsymptomsPatientEvaluationHistoryDocumentationofheight,weight,musclestrength,balance,visionDocumentationofmedicalhistoryDocumentationofmenstrualhistory,infertilityinmenFracturehistoryandFamilyhistoryoffracturesOtherriskfactorsforosteoporosis:

@#@-Lifestylesinfluences:

@#@calciumandvitaminDintake,smoking,alcoholintake,medications,preventionoffalling-Patienteducation:

@#@preventionoffalling,exerciseGeneralhealthandprognosisPatientEvaluationPhysicalexaminationEvidenceofosteoporosis:

@#@evidenceoffracture,kyphosis,lossofheight,musclestrengthandsizeGeneralphysicalfindings:

@#@assessmentofunderlyingdisorder,othermedicalconditionsPatientEvaluationCompletebloodcountanderythrocytesedimentationrate（ESR）Serumcalcium,phosphate,creatinine,electrolyte,alkalinephosphatase,25-hydroxyvitaminD,estradiol,testosterone（male）24hr-UrinarycalciumandcreatinineBMDofspineandhipX-raysofappropriateareaslaboratory