References

mrj

Современная ревматология

Modern Rheumatology Journal

1996-70122310-158X

IMA-PRESS, LLC

10.14412/1996-7012-2014-2-107-110

mrj-544

Research Article

ФАРМАКОТЕРАПИЯ

PHARMACOTHERAPY

Новые возможности лечения глюкокортикоидного остеопороза

New possibilities for the treatment of glucocorticoid-induced osteoporosis

Баранова

И.А.

Baranova

I.A.

1@ru.ru

ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, РоссияРоссияN.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, RussiaRussian Federation

2014

08052014

82107110

2014

Баранова И.

Baranova I.

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/544

Глюкокортикоид-индуцированный остеопороз (ГКОП) – наиболее частая причина вторичного ОП и основная причина лекарственного ОП. Переломы костей скелета регистрируют у 30–50% больных, длительно принимающих пероральные ГК, причем эти переломы развиваются при использовании любой суточной дозы ГК и при более высоких показателях минеральной плотности кости (МПК), чем при постменопаузальном ОП. У больных, длительно или в высоких суточных дозах принимающих пероральные ГК, уменьшение МПК и ухудшение качества костной ткани, приводящие к развитию переломов, в большей степени связаны со снижением костного формирования. Это обосновывает применение противоостеопоротических препаратов, повышающих формирование кости в процессе ее ремоделирования. Терипаратид – рекомбинантный человеческий паратиреоидный гормон – усиливает функцию остеобластов, уменьшает апоптоз остеобластов и остеоцитов, увеличивает дифференцировку предшественников остеобластов и способен предотвращать негативное влияния экзогенных ГК на кость. По данным клинических исследований, лечение терипаратидом увеличивает МПК и снижает риск переломов позвонков у лиц, длительно принимающих пероральные ГК. Согласно клиническим рекомендациям по диагностике, профилактике и лечению ГКОП, разработанными Российской Ассоциацией по остеопорозу совместно с Ассоциацией ревматологов России и Российским респираторным обществом, терипаратид является препаратом первого выбора для лечения ГКОП у мужчин и женщин с высоким риском переломов (низкоэнергетические переломы в анамнезе или высокий 10-летний абсолютный риск основных остеопоротических переломов по FRAX). Терипаратид может быть назначен при неэффективности предшествующей антиостеопоротической терапии (новые переломы, возникшие на фоне лечения, и/или продолжающееся снижение МПК), а также при непереносимости других препаратов для лечения ОП или при наличии противопоказаний для их использования.

Glucocorticoid-induced osteoporosis (GIO) is the most common cause of secondary osteoporosis (OP) and a main cause of drug-induced OP. Fractures of the skeleton are registered in 30–50% of patients who have taken oral glucocorticoids (GCs) for a long time, during which the frac- tures develop with the use of any daily GC dose and with higher bone mineral density (BMD) than in postmenopausal OP. In patients who have taken oral GCs long or in high daily doses, decrease of BMD and low bone tissue quality leading to fractures are largely associated with the reduction of bone formation. This gives proof to the administration of antiosteoporotic agents that enhance the formation of bone during its remodeling. Teriparatide, a recombinant human parathyroid hormone, enhances osteoblast function, decreases the apoptosis of osteoblasts and osteocytes, increases the differentiation of osteoblast precursors, and can prevent the negative effect of exogenous GCs on bone. According to clinical trials results, teriparatide treatment increases BMD and reduces the risk of vertebral fractures in patients who have taken oral GCs long. In accordance of the clinical recommendations for the diagnosis, prevention, and treatment of GIO, which have been developed by the Russian Osteoporosis Association jointly with the Association of Rheumatologists of Russia and the Russian Respiratory Society, teriparatide is the drug of first choice for the treatment of GIO in men and women at high risk for fractures (with the history of fragility fractures or having high FRAX 10-year absolute fracture risk). Teriparatide may be prescribed in case of previous antiosteoporotic treatment failure (new fractures occurring during treatment and/or continuing to decrease BMD), as well as when other drugs to treat OP are intolerable or when there are contraindications to their use.

люкокортикоидыостеопорозлечениетерипаратид.

glucocorticosteroidsosteoporosistreatmentteriparatide.

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