mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2008-455mrj-140Research ArticleСтатьиArticlesГлюкокортикоидиндуцированный остеопороз: патогенез, профилактика, лечениеGlucocorticosteroid-induced osteoporosis: pathogenesis, prevention, treatmentБарановаИ. А.BaranovaI A-БарановаИ. А.BaranovaI A-20081503200821№1 (2008)3139Copyright © Баранова И.А., Баранова И.А., 20082008Баранова И.А., Баранова И.А.Baranova I.A., Baranova I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/140

Глюкокортикоидиндуцированный остеопороз (ГИО) - одно из наиболее тяжелых осложнений длительной (более 3 мес) системной терапии глюкокортикоидами (СГК). Он развивается у больных любого возраста и пола и является наиболее частой системной формой вторичного остеопороза (ОП). Быстрая потеря костной массы происходит уже в первые месяцы лечения СГК. Переломы от минимальной травмы возникают при более высоких показателях минеральной плотности кости, чем у больных первичным ОП. Даже использование малых доз СГК приводит к повышению риска переломов, с увеличением суточной дозы риск переломов возрастает. У пациентов, применяющих высокие дозы ингаляционных ГК (ИГК), увеличение риска ОП и переломов в большей степени обусловлено тяжестью респираторного заболевания, чем терапией ИГК. Представлены современные принципы профилактики и лечения ГИО.

Glyukokortikoidindutsirovannyy osteoporoz (GIO) - odno iz naibolee tyazhelykh oslozhneniy dlitel'noy (bolee 3 mes) sistemnoy terapii glyukokortikoidami (SGK). On razvivaetsya u bol'nykh lyubogo vozrasta i pola i yavlyaetsya naibolee chastoy sistemnoy formoy vtorichnogo osteoporoza (OP). Bystraya poterya kostnoy massy proiskhodit uzhe v pervye mesyatsy lecheniya SGK. Perelomy ot minimal'noy travmy voznikayut pri bolee vysokikh pokazatelyakh mineral'noy plotnosti kosti, chem u bol'nykh pervichnym OP. Dazhe ispol'zovanie malykh doz SGK privodit k povysheniyu riska perelomov, s uvelicheniem sutochnoy dozy risk perelomov vozrastaet. U patsientov, primenyayushchikh vysokie dozy ingalyatsionnykh GK (IGK), uvelichenie riska OP i perelomov v bol'shey stepeni obuslovleno tyazhest'yu respiratornogo zabolevaniya, chem terapiey IGK. Predstavleny sovremennye printsipy profilaktiki i lecheniya GIO.

References<div><p>Walsh L.J., Wong C., Pringle M.et al. Use of oral glucocorticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ 1996; 313: 344-6.</p><p>Van Staa T.P., Leufkens H.G.M., Abenhaim L. et al. Use of oral glucocorticosteroids in the United Kingdom. QJM 2000; 93: 105-11.</p><p>Kanis J.A., Stevenson M., McCloskey E.V. et al. Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis. Health Technology Assessment 2007; 11: 7.</p><p>Lane N.E., Sanchez S., Modin G.W. et al. Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial. J Clin Invest 1999; 102: 1627-33.</p><p>Plotkin L.I., Weinstein R.S., Parfitt A.M. et al. Prevention of osteocyte and osteoblast apoptosis by bisphosphonates and calcitonin. J Clin Invest 1999; 104: 1363-74.</p><p>Hofbauer L.C., Gori F., Riggs B.L. et al. Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic lineage cells: potential paracrine mechanisms of glucocorticoid-induced osteoporosis. Endocrinology 1999; 140(10): 4382-9.</p><p>Cooper M.S., Rabbitt E.H., Goddard P.E. et al. Osteoblastic 1-hydroxysteroid dehydrogenase type 1 activity increases with age and glucocorticoid exposure. J Bone Miner Res 2002; 17: 979-86.</p><p>Van Staa T.P. The pathogenesis, epidemiology and management of glucocorticoid-induced osteoporosis. Calcif Tissue Int 2006; 79: 129-37.</p><p>Gennari C., Imbimbo B. Effects of pred-nisone and deflazacort on vertebral bone mass. Calcif Tis Int 1985; 37: 592-93.</p><p>Cranney A., Welch V., Adachi J.D. et al. Calcitonin for the treatment and prevention of coericosteroid-induced osteoporosis. The Cochrane Library 2004; Issue I, CD 001983.</p><p>Van Staa T.P., Leufkens H.G.M., Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 2002; 13: 777-87.</p><p>Angeli A., Guglielmi G., Dovio A. et al High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone 2006; 39: 253-59.</p><p>WHO Study Group «Assesment of fracture risk and its application to screening for postmenopausal osteoporosis». Geneva: World Health Organization, 1994.</p><p>Van Staa T.P., Laan R.F., Barton I.P. et al. Bone density threshold and other predictors of vertebral fracture in patients receiving glucocorticoid therapy. Arthritis Rheum 2003; 48 (11): 3224-29.</p><p>Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. 2001 Update. American College of Rheumatology ad hoc committee on glucocorticoid-induced osteoporosis. Arthritis Rheum 2001; 44( 7): 1496-503.</p><p>Eastell R., Reid D.M., Compston J.E. et al. A UK consensus group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med 1998; 244: 271-92.</p><p>Van Staa T., Leufkens H.G.M., Abenhaim L. et al. Use of oral corticosteroids and risk of fractures. J Bone Miner Res 2000; 15: 993-1000.</p><p>Matsumoto H., Ishihara K., Hasegawa T. et al. Effects of inhaled corticosteroid and short courses of oral corticosteroids on bone mineral density in asthmatic patients. A 4-year longitudinal study. Chest 2001; 120: 1468-73.</p><p>Van Staa T.P., Cooper C., Leufkens H.G. et al. Children and the risk of fractures caused by oral corticosteroids. J Bone Miner Res 2003; 18 (5): 913-18.</p><p>Vestergaard P., Olsen ML., Paaske Johnsen S. et al. Corticosteroid use and risk of hip fracture: a population-based case-control study in Denmark. J Intern 2003; 254 (5): 486-93.</p><p>Mortimer K.J., Harrison T.W., Tattersfield A.E. Effects of inhaled corticosteroids on bone. Ann Allergy Asthma Immunol 2005; 94 (1): 15-21.</p><p>Mash B., Bheekie A., Jones P.W. Inhaled versus oral steroids for adults with bronchial asthma. The Cochrane Library 2002; Issue (3), CD 002161.</p><p>Global Strategy for Asthma Management and Prevention. www.ginasthma.org &lt;http://www.ginasthma.org&gt;.</p><p>The Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med 2000; 343: 1902-09.</p><p>Jones A., Fay J.K., Burr M. et al. Inhaled corticosteroid effects on bone metabolism in asthma and mild obstructive pulmonary disease. The Cochrane Library 2002; Issue 3, CD 003537.</p><p>Richy F., Bousquet J., Ehrlich G.E. et al. Inhaled corticosteroids effects on bone in asthmatic and COPD patients: a quantitative systemic review. Osteoporos Int 2003; 14 (3): 179-90.</p><p>Hubbard R.B., Smith C.J.P., Smeeth L. et al. Inhaled corticosteroids and hip fracture. Am J Resp Crit. Care Med 2002; 166: 1563-66.</p><p>Lee T.A., Weiss K.B. Fracture risk associated with inhaled corticosteroid use in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004; 169: 855-59.</p><p>Suissa S., Baltzan M., Kremer R.et al. Inhaled and nasal corticosteroid use and the risk of fracture. Am J Respir Crit Care.Med 2004; 169 (1): 83-8.</p><p>Health Care Guideline: diagnosis and treatment of osteoporosis. Institute for Clinical System Improvement, 2004.</p><p>De Vries F., Van Staa T.P., Bracke M.S.G.M. et al. Severity of obstructive airway disease and risk of osteoporotic fracture. Eur Respir J 2005; 25: 879-84.</p><p>Van Staa T.P., Leufkens H.G., Cooper C. Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res 2001; 16 : 581-88.</p><p>Van Staa T.P., Bishop N., Leufkens H.G.et al. C. Are inhaled corticosteroids associated with an increased risk of fracture in children? Osteoporos Int 2004; 15 (10): 785-91.</p><p>Homic J., Suarez-Almazor M.E., Shea B. et al. Calcium and vitamin D for corticosteroid-induced osteoporosis (Cochrane Review). The Cochrane Library 2004; Issue I, CD 000952.</p><p>Adachi J.D., Saag K.J., Delmas P.D. et al. Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial. Arthritis &amp; Rheumatism 2001; 44 (1) 202-11.</p><p>Sambrook P.N., Kotowicz M., Nash M. et al. Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium. J Bone Miner Res 2003; 18 (5): 919-24.</p><p>Patlas N., Golomb G., Yaffe P. et al. Transplacental effects of bisphosphonates on fetal skeletal ossification and mineralization in rats. Teratology 1999; 60 (2) : 68-73.</p><p>Knopp J.A., Diner B.M., Blitz M. et al. Calcitonin for treating acute pain of osteopotic compression fractures: a systemic review of randomized, controlled trials. Osteoporos Int 2005; 16 (10): 1281-90.</p><p>Richy F., Schacht E., Bruyere O. et al. Vitamin D analogs versus native vitamin D in preventing bone loss and osteoporosis-related fractures: a comparative meta-analysis. Calcif Tissue Int 2005; 76 (3) : 176-86.</p><p>Ringe J.D., Dorst A., Faber H. et al. Superiority of alfacalcidol over plain vaitamin D in the treatment of glucocorticoid-induced osteoporosis. Rheumatol Int 2004; 24 (2) : 63-70.</p><p>Reid I.R., Ibbertson H.K., France J.T. et al. Plasma testosterone concentrations in asthmatic men treated with glucocorticoids. BMJ 1985; 291: 574.</p><p>Lukert B.P., Johnson B.E., Robinson R.G. Estrogen and progesterone replacement therapy reduced glucocorticoid-induced bone loss. J Bone Miner Res 1992; 7: 1063-69.</p><p>Lane N.E., Sanchez S., Genant H.K. et al. Short-term increase in bone turnover markers predict parathyroid hormone-induced spinal bone mineral density gains in postmenopausal women with osteoporosis. Osteoporos Int 2000; 11: 434-42.</p><p>Hodsman A.B., Bauer D.C., Dempster D. et al. Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev 2005; 349: 688-703.</p></div><br /><div><p>Walsh L.J., Wong C., Pringle M.et al. Use of oral glucocorticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ 1996; 313: 344-6.</p><p>Van Staa T.P., Leufkens H.G.M., Abenhaim L. et al. Use of oral glucocorticosteroids in the United Kingdom. QJM 2000; 93: 105-11.</p><p>Kanis J.A., Stevenson M., McCloskey E.V. et al. Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis. Health Technology Assessment 2007; 11: 7.</p><p>Lane N.E., Sanchez S., Modin G.W. et al. Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial. J Clin Invest 1999; 102: 1627-33.</p><p>Plotkin L.I., Weinstein R.S., Parfitt A.M. et al. Prevention of osteocyte and osteoblast apoptosis by bisphosphonates and calcitonin. J Clin Invest 1999; 104: 1363-74.</p><p>Hofbauer L.C., Gori F., Riggs B.L. et al. Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic lineage cells: potential paracrine mechanisms of glucocorticoid-induced osteoporosis. Endocrinology 1999; 140(10): 4382-9.</p><p>Cooper M.S., Rabbitt E.H., Goddard P.E. et al. Osteoblastic 1-hydroxysteroid dehydrogenase type 1 activity increases with age and glucocorticoid exposure. J Bone Miner Res 2002; 17: 979-86.</p><p>Van Staa T.P. The pathogenesis, epidemiology and management of glucocorticoid-induced osteoporosis. Calcif Tissue Int 2006; 79: 129-37.</p><p>Gennari C., Imbimbo B. Effects of pred-nisone and deflazacort on vertebral bone mass. Calcif Tis Int 1985; 37: 592-93.</p><p>Cranney A., Welch V., Adachi J.D. et al. Calcitonin for the treatment and prevention of coericosteroid-induced osteoporosis. The Cochrane Library 2004; Issue I, CD 001983.</p><p>Van Staa T.P., Leufkens H.G.M., Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 2002; 13: 777-87.</p><p>Angeli A., Guglielmi G., Dovio A. et al High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone 2006; 39: 253-59.</p><p>WHO Study Group «Assesment of fracture risk and its application to screening for postmenopausal osteoporosis». Geneva: World Health Organization, 1994.</p><p>Van Staa T.P., Laan R.F., Barton I.P. et al. Bone density threshold and other predictors of vertebral fracture in patients receiving glucocorticoid therapy. Arthritis Rheum 2003; 48 (11): 3224-29.</p><p>Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. 2001 Update. American College of Rheumatology ad hoc committee on glucocorticoid-induced osteoporosis. Arthritis Rheum 2001; 44( 7): 1496-503.</p><p>Eastell R., Reid D.M., Compston J.E. et al. A UK consensus group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med 1998; 244: 271-92.</p><p>Van Staa T., Leufkens H.G.M., Abenhaim L. et al. Use of oral corticosteroids and risk of fractures. J Bone Miner Res 2000; 15: 993-1000.</p><p>Matsumoto H., Ishihara K., Hasegawa T. et al. Effects of inhaled corticosteroid and short courses of oral corticosteroids on bone mineral density in asthmatic patients. A 4-year longitudinal study. Chest 2001; 120: 1468-73.</p><p>Van Staa T.P., Cooper C., Leufkens H.G. et al. Children and the risk of fractures caused by oral corticosteroids. J Bone Miner Res 2003; 18 (5): 913-18.</p><p>Vestergaard P., Olsen ML., Paaske Johnsen S. et al. Corticosteroid use and risk of hip fracture: a population-based case-control study in Denmark. J Intern 2003; 254 (5): 486-93.</p><p>Mortimer K.J., Harrison T.W., Tattersfield A.E. Effects of inhaled corticosteroids on bone. Ann Allergy Asthma Immunol 2005; 94 (1): 15-21.</p><p>Mash B., Bheekie A., Jones P.W. Inhaled versus oral steroids for adults with bronchial asthma. The Cochrane Library 2002; Issue (3), CD 002161.</p><p>Global Strategy for Asthma Management and Prevention. www.ginasthma.org &lt;http://www.ginasthma.org&gt;.</p><p>The Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med 2000; 343: 1902-09.</p><p>Jones A., Fay J.K., Burr M. et al. Inhaled corticosteroid effects on bone metabolism in asthma and mild obstructive pulmonary disease. The Cochrane Library 2002; Issue 3, CD 003537.</p><p>Richy F., Bousquet J., Ehrlich G.E. et al. Inhaled corticosteroids effects on bone in asthmatic and COPD patients: a quantitative systemic review. Osteoporos Int 2003; 14 (3): 179-90.</p><p>Hubbard R.B., Smith C.J.P., Smeeth L. et al. Inhaled corticosteroids and hip fracture. Am J Resp Crit. Care Med 2002; 166: 1563-66.</p><p>Lee T.A., Weiss K.B. Fracture risk associated with inhaled corticosteroid use in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004; 169: 855-59.</p><p>Suissa S., Baltzan M., Kremer R.et al. Inhaled and nasal corticosteroid use and the risk of fracture. Am J Respir Crit Care.Med 2004; 169 (1): 83-8.</p><p>Health Care Guideline: diagnosis and treatment of osteoporosis. Institute for Clinical System Improvement, 2004.</p><p>De Vries F., Van Staa T.P., Bracke M.S.G.M. et al. Severity of obstructive airway disease and risk of osteoporotic fracture. Eur Respir J 2005; 25: 879-84.</p><p>Van Staa T.P., Leufkens H.G., Cooper C. Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res 2001; 16 : 581-88.</p><p>Van Staa T.P., Bishop N., Leufkens H.G.et al. C. Are inhaled corticosteroids associated with an increased risk of fracture in children? Osteoporos Int 2004; 15 (10): 785-91.</p><p>Homic J., Suarez-Almazor M.E., Shea B. et al. Calcium and vitamin D for corticosteroid-induced osteoporosis (Cochrane Review). The Cochrane Library 2004; Issue I, CD 000952.</p><p>Adachi J.D., Saag K.J., Delmas P.D. et al. Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial. Arthritis &amp; Rheumatism 2001; 44 (1) 202-11.</p><p>Sambrook P.N., Kotowicz M., Nash M. et al. Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium. J Bone Miner Res 2003; 18 (5): 919-24.</p><p>Patlas N., Golomb G., Yaffe P. et al. Transplacental effects of bisphosphonates on fetal skeletal ossification and mineralization in rats. Teratology 1999; 60 (2) : 68-73.</p><p>Knopp J.A., Diner B.M., Blitz M. et al. Calcitonin for treating acute pain of osteopotic compression fractures: a systemic review of randomized, controlled trials. Osteoporos Int 2005; 16 (10): 1281-90.</p><p>Richy F., Schacht E., Bruyere O. et al. Vitamin D analogs versus native vitamin D in preventing bone loss and osteoporosis-related fractures: a comparative meta-analysis. Calcif Tissue Int 2005; 76 (3) : 176-86.</p><p>Ringe J.D., Dorst A., Faber H. et al. Superiority of alfacalcidol over plain vaitamin D in the treatment of glucocorticoid-induced osteoporosis. Rheumatol Int 2004; 24 (2) : 63-70.</p><p>Reid I.R., Ibbertson H.K., France J.T. et al. Plasma testosterone concentrations in asthmatic men treated with glucocorticoids. BMJ 1985; 291: 574.</p><p>Lukert B.P., Johnson B.E., Robinson R.G. Estrogen and progesterone replacement therapy reduced glucocorticoid-induced bone loss. J Bone Miner Res 1992; 7: 1063-69.</p><p>Lane N.E., Sanchez S., Genant H.K. et al. Short-term increase in bone turnover markers predict parathyroid hormone-induced spinal bone mineral density gains in postmenopausal women with osteoporosis. Osteoporos Int 2000; 11: 434-42.</p><p>Hodsman A.B., Bauer D.C., Dempster D. et al. Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev 2005; 349: 688-703.</p></div><br />

The authors declare that there are no conflicts of interest present.