類固醇引起的骨質疏鬆症

Glucocorticoid-induced Osteoporosis (GIOP)

1930 年代類固醇開始大量使用，Harvey Cushing 在1932 年就描述過高的類固醇劑量和骨折的關聯。在英國，類固醇被使用於0.5%至2.5%的成年人[1]，因此，類固醇引起骨質疏鬆症（骨鬆症）或骨折是最常見的併發症之一，類固醇是否會引起骨質疏鬆症或骨折，取決定於每天和累積的劑量，還受其他因素影響，包括基礎骨密度（BMD）、年齡、性別、荷爾蒙狀態、原來疾病是否仍存在，以及個人對類固醇的敏感性等，從加拿大長達10 年的研究報告顯示，服用類固醇治療的病患，只有約四分之一的病患曾骨接受骨密度檢查或治療[2]，而在美國使用類固醇的患者只有8.6%同時接受雙磷酸塩藥物[3]，因此，讓第一線照顧的醫師和長期使用類固醇的患者瞭解如何避免及有效治療類固醇引起的骨質疏鬆症，是非常重要的。

Harvey Cushing first described the association between excess endogenous glucocorticoids and fractures in 1932. In United Kingdom, glucocorticoids are used by 0.5% to 2.5% of adults [1]. Therefore, glucocorticoid-induced osteoporosis or fracture is one of the most common adverse effects. Whether the patient will develop GIOP depends not only on the daily and cumulative dose of glucocorticoids but also on several other factors, including the patient's baseline bone mineral density(BMD), age, gender, hormonal status, underlying disease, and individual differences in sensitivity to glucocorticoids. One 10-year study from Canada reported that only one quarter of those starting long-term glucocorticoids receiving BMD testing or osteoporosis treatment [2]. In US, only 8.6% of chronic glucocorticoid users received concomitant bisphosphonate(s) to prevent GIOP [3]. It is very important to make primary care physicians and patients aware about the knowledge about osteoporosis, especially with regards to effective counteraction and prevention rules in patients who underwent chronic steroid therapy.