CAJ | 학술논문

近年来，随着糖皮质激素在临床广泛应用，糖皮质激素性骨质疏松发病率不断上升，在骨质疏松症中其发病率居于第三位，仅次于绝经后骨质疏松及老年性骨质疏松。糖皮质激素除了促进成骨细胞和骨细胞凋亡、降低成骨功能，抑制骨胶原及促进破骨细胞生成并延长其生存时间等直接抑制成骨，还通过调节内分泌及相关细胞因子、抑制骨局部血流量等间接影响骨形成。2008年FRAX工具的推出重新定义了糖皮质激素性骨质疏松风险度，为临床的诊治带来便利。针对其发生脆性骨折的风险，2010年ACR共识对其防治做出了新的调整和推荐，重点强调了双磷酸盐在防治糖皮质激素导致的脆性骨折方面的作用，同时甲状旁腺激素、充足的维生素、钙剂等在有效防治糖皮质性骨质疏松方面也起了重要作用。
근년래，수착당피질격소재림상엄범응용，당피질격소성골질소송발병솔불단상승，재골질소송증중기발병솔거우제삼위，부차우절경후골질소송급노년성골질소송。당피질격소제료촉진성골세포화골세포조망、강저성골공능，억제골효원급촉진파골세포생성병연장기생존시간등직접억제성골，환통과조절내분비급상관세포인자、억제골국부혈류량등간접영향골형성。2008년FRAX공구적추출중신정의료당피질격소성골질소송풍험도，위림상적진치대래편리。침대기발생취성골절적풍험，2010년ACR공식대기방치주출료신적조정화추천，중점강조료쌍린산염재방치당피질격소도치적취성골절방면적작용，동시갑상방선격소、충족적유생소、개제등재유효방치당피질성골질소송방면야기료중요작용。
Glucocorticoids are widely used in the clinic in recent years.The incidence of glucocorticoid-induced osteoporosis is rising up.It is now the third most frequent cause of secondary osteoporosis besides postmenopausal and senile osteoporosis.The pathological mechanism of glucocorticoid-induced osteoporosis is that glucocorticoids inhibit osteogenesis not only by promoting apoptosis of osteoblast and osteocyte, reducing the collagen and promoting osteoblast formation and prolonging the survival time, but also by regulating endocrine system and related cytokines, reducing blood flow in bone to influence bone formation.In 2008, FRAX was established to redefine the risk probability of glucocorticoid-induced osteoporosis, to facilitate the clinical use.The ACR 2010 consensus suggested the new adoption and recommendation focusing on the risk of fragile fracture.It emphasized the use of bisphosphonates for the prevention and treatment of glucocorticoid-induced osteoporosis.Parathyroid hormone, adequate vitamin and calcium supplement also play an important role in the prevention and treatment of glucocorticoid-induced osteoporosis.