新指南,新启示课件.pptx

新指南,新启示糖皮质激素引起的骨质疏松( GIOP ) 女性骨质疏松发病原因男性骨质疏松发病原因 GC 是继发性骨质疏松症的首要原因, GIOP 在所有骨质疏松中占第三位, 仅次于绝经后骨质疏松和老年性骨质疏松糖皮质激素是继发性骨质疏松症的首要原因 HANSEN L B, VONDRACEK S F. Prevention and treatment ofnonpostmenopausal osteoporosis[ J]. Am J Health Syst Pharm,2004, 61(24): 2637-2654. 其它原因原发性口服类固醇激素性腺功能低下肿瘤嗜酒 80 年前已认识到糖皮质激素与骨丢失的关系? 1932 年,美国神经外科医生 Harvey Cushing 首次描述了内源性皮质醇增多症导致的骨密度降低和骨折? 1954 年(强的松开始用于类风湿性关节炎仅几年),研究人员报道了外源性糖皮质激素对骨骼的不良影响 Cushing H. Bull Johns Hopkins Hosp 1932, 50:137 – 95. Curtis PH, et al. JAMA 1954, 156:467 – 9. 进入新世纪, GIOP 成为各国的关注重点?中华医学会骨质疏松和骨矿盐疾病分会《糖皮质激素性骨质疏松症诊治指南》( 2006 ) ? American College of Rheumatology ad mittee on Glucocorticoid-induced Osteoporosis (2001) mendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update ? Royal College of Physicians (2002) Glucocorticoid-induced osteoporosis. Guidelines on prevention and treatment. Bone and Tooth Society of Great Britain, National Osteoporosis Society and Royal College of Physicians ? Scientific Advisory Council of the Osteoporosis Society of Canada (2002) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. ?(2006) Evidence-based guidelines for the prevention and treatment of glucocorticoidinduced osteoporosis: a consensus document of the Belgian Bone Club . ? (2006) Review and evaluation of the Dutch guidelines for osteoporosis ?(2007) EULAR evidencebased mendations on the management of systemic glucocorticoid therapy in rheumatic diseases ? mittee to Study Diagnostic Criteria for Glucocorticoid-Induced Osteoporosis (2005) Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research(2004 ). 2010-2012 年两项新的 GIOP 指南发布 JENNIFER M. GROSSMAN, et al. Arthritis Care & Research,2010;62(11):1515-1526 S. Lekamwasam, et al. Osteoporos Int, published online 21 March 2012 今天的内容? PART 1 :糖皮质激素引起骨改变的病理机制? PART 2 : GIOP 新指南解读糖皮质激素治疗导致骨量流失 van Staa TP, et al.