糖皮质激素性骨质疏松症研究进展

doi:10.6040/j.issn.1671-7554.0.2021.0481

摘要/Abstract

摘要： 糖皮质激素广泛用于治疗各种过敏性和自身免疫性疾病。糖皮质激素性骨质疏松症(GIOP)是长期应用糖皮质激素的不良反应之一,其特征是持续性骨形成下降,伴骨吸收增加,导致骨折发生率增加,给患者带来严重危害。本文对GIOP的发病机制和防治药物进行综述,旨在提高临床医生对GIOP的重视。

关键词: 糖皮质激素, 骨质疏松症, 成骨细胞, 破骨细胞

Abstract: Glucocorticoids are widely used in the treatment of allergic and autoimmune diseases. Glucocorticoid-induced osteoporosis(GIOP)is one of the adverse reactions of long-term application of glucocorticoids, which is characterized by continuous decrease of bone formation accompanied by increase of bone resorption, leading to increased incidence of fracture and bringing serious harm to patients. Herein, we review the pathogenesis of GIOP and its prevention and treatment drugs, in order to raise the attention of clinicians to GIOP.

Key words: Glucocorticoids, Osteoporosis, Osteoblast, Osteoclast

中图分类号:

R574

陈诗鸿. 糖皮质激素性骨质疏松症研究进展[J]. 山东大学学报 (医学版), 2021, 59(6): 33-37.

CHEN Shihong. Progress in glucocorticoid-induced osteoporosis[J]. Journal of Shandong University (Health Sciences), 2021, 59(6): 33-37.

参考文献

[1] 张学武, 姚海红, 梅轶芳, 等. 全国多中心使用糖皮质激素风湿病患者骨质疏松调查[J]. 中华临床免疫和变态反应杂志, 2017, 11(3): 277-284. ZHANG Xuewu, YAO Haihong, MEI Yifang, et al. Survey on glucocorticosteriod associated osteoporosis in patients with rheumatic diseases in China 2013[J]. Chinese Journal of Allergy and Clinical Immunology, 2017, 11(3): 277-284.
[2] Buckley L, Guyatt G, Fink HA, et al. 2017 American college of rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis [J]. Arthrit Rheumatol, 2017, 69(8): 1521-1537.
[3] 中国医师协会风湿免疫科医师分会,中华医学会风湿病学分会,中华医学会骨质疏松和骨矿盐疾病分会,等. 2020版中国糖皮质激素性骨质疏松症防治专家共识[J]. 中华内科杂志, 2021, 60(1): 13-21.
[4] Lane NE. Glucocorticoid-induced osteoporosis: new insights into the pathophysiology and treatments [J]. Curr Osteoporos Rep, 2019, 17(1): 1-7.
[5] Hartmann K, Koenen M, Schauer S, et al. Molecular actions of glucocorticoids in cartilage and bone during health, disease, and steroid therapy [J]. Physiol Rev, 2016, 96(2): 409-447.
[6] Hachemi Y, Rapp AE, Picke AK, et al. Molecular mechanisms of glucocorticoids on skeleton and bone regeneration after fracture [J]. J Mol Endocrinol, 2018, 61(1): R75-R90.
[7] Yang YJ, Zhu Z, Wang DT, et al. Tanshinol alleviates impaired bone formation by inhibiting adipogenesis via KLF15/PPARgamma2 signaling in GIO rats [J]. Acta Pharmacol Sin, 2018, 39(4): 633-641.
[8] Han L, Wang B, Wang R, et al. The shift in the balance between osteoblastogenesis and adipogenesis of mesenchymal stem cells mediated by glucocorticoid receptor [J]. Stem Cell Res Ther, 2019, 10(1): 377.
[9] Zanotti S, Yu J, Adhikari S, et al. Glucocorticoids inhibit notch target gene expression in osteoblasts [J]. J Cell Biochem, 2018, 119(7): 6016-6023.
[10] Deng S, Dai G, Chen S, et al. Dexamethasone induces osteoblast apoptosis through ROS-PI3K/AKT/GSK3β signaling pathway [J]. Biomed Pharmacother, 2019, 110: 602-608. doi: 10.1016/j.biopha.2018.11.103.
[11] Lian W, Ko J, Chen Y, et al. Chaperonin 60 sustains osteoblast autophagy and counteracts glucocorticoid aggravation of osteoporosis by chaperoning RPTOR [J]. Cell Death Dis, 2018, 9(10): 938.
[12] Wang T, Liu X, He C. Glucocorticoid-induced autophagy and apoptosis in bone [J]. Apoptosis, 2020, 25(3-4): 157-168.
[13] Fu L, Wu W, Sun X, et al. Glucocorticoids enhanced osteoclast autophagy through the PI3K/Akt/mTOR signaling pathway [J]. Calcif Tissue Int, 2020, 107(1): 60-71.
[14] Conaway HH, Henning P, Lie A, et al. Activation of dimeric glucocorticoid receptors in osteoclast progenitors potentiates RANKL induced mature osteoclast bone resorbing activity [J]. Bone, 2016, 93: 43-54. doi: 10.1016/j.bone.2016.08.024.
[15] Li HX, Li DH, Ma ZM, et al. Defective autophagy in osteoblasts induces endoplasmic reticulum stress and causes remarkable bone loss [J]. Autophagy, 2018, 14(10): 1726-1741.
[16] Gan ZY, Fitter S, Vandyke K, et al. The effect of the dual PI3K and mTOR inhibitor BEZ235 on tumour growth and osteolytic bone disease in multiple myeloma [J]. Eur J Haematol, 2015, 94(4): 343-354.
[17] Florez H, Hernández-Rodríguez J, Muxi A, et al. Trabecular bone score improves fracture risk assessment in glucocorticoid-induced osteoporosis [J]. Rheumatology, 2020, 59(7): 1574-1580.
[18] Chotiyarnwong P, McCloskey EV. Pathogenesis of glucocorticoid-induced osteoporosis and options for treatment [J]. Nat Rev Endocrinol, 2020, 16(8): 437-447.
[19] Ding L, Hu J, Wang D, et al. Efficacy and safety of first- and second-line drugs to prevent glucocorticoid-induced fractures [J]. J Clin Endocrinol Metab, 2020, 105(1): dgz023. doi: 10.1210/clinem/dgz023.
[20] Matsumoto T, Yamamoto K, Takeuchi T, et al. Eldecalcitol is superior to alfacalcidol in maintaining bone mineral density in glucocorticoid-induced osteoporosis patients(e-GLORIA)[J]. J Bone Miner Metab, 2020, 38(4): 522-532.
[21] Adami G, Saag KG. Glucocorticoid-induced osteoporosis: 2019 concise clinical review[J]. Osteoporos Int, 2019, 30(6): 1145-1156.
[22] Bergman J, Nordström A, Nordström P. Alendronate use and the risk of nonvertebral fracture during glucocorticoid therapy: a retrospective cohort study [J]. J Clin Endocrinol Metab, 2018, 103(1): 306-313.
[23] Kan S, Yuan Z, Li Y, et al. Alendronate prevents glucocorticoid-induced osteoporosis in patients with rheumatic diseases [J]. Medicine(Baltimore), 2016, 95(25): e3990. doi: 10.1097/MD.0000000000003990.
[24] Lv F, Guan Y, Ma D, et al. Effects of alendronate and alfacalcidol on bone in patients with myasthenia gravis initiating glucocorticoids treatment [J]. Clin Endocrinol(Oxf), 2018, 88(3): 380-387.
[25] Saag KG, Pannacciulli N, Geusens P, et al. Denosumab versus risedronate in glucocorticoid-induced osteoporosis: final results of a twenty-four-month randomized, double-blind, double-dummy trial [J]. Arthritis Rheumatol, 2019, 71(7): 1174-1184.
[26] Yanbeiy ZA, Hansen KE. Denosumab in the treatment of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis [J]. Drug Des Devel Ther, 2019, 13: 2843-2852. doi:10.2147/DDDT.S148654.
[27] Taylor AD, Saag KG. Anabolics in the management of glucocorticoid-induced osteoporosis: an evidence-based review of long-term safety, efficacy and place in therapy [J]. Core Evid, 2019, 14: 41-50. doi: 10.2147/CE.S172820.
[28] Tanaka I, Tanaka Y, Soen S, et al. Efficacy of once-weekly teriparatide in patients with glucocorticoid-induced osteoporosis: the TOWER-GO study [J]. J Bone Miner Metab, 2021, 39(3): 446-455.
[29] Chandler H, Brooks DJ, Hattersley G, et al. Abaloparatide increases bone mineral density and bone strength in ovariectomized rabbits with glucocorticoid-induced osteopenia [J]. Osteoporos Int, 2019, 30(8): 1607-1616.
[30] Yoon SH, Grynpas MD, Mitchell J. Growth hormone increases bone toughness and decreases muscle inflammation in glucocorticoid-treated Mdx mice, model of duchenne muscular dystrophy [J]. J Bone Miner Res, 2019, 34(8): 1473-1486.
[31] Sato AY, Cregor M, McAndrews K, et al. Glucocorticoid-induced bone fragility is prevented in female mice by blocking Pyk2/Anoikis signaling [J]. Endocrinology, 2019, 160(7): 1659-1673.
[32] Ren H, Yu X, Shen G, et al. miRNA-seq analysis of human vertebrae provides insight into the mechanism underlying GIOP [J]. Bone, 2019, 120: 371-386.doi: 10.1016/j.bone.2018.11.013.
[33] Shen G, Ren H, Shang Q, et al. Let-7f-5p regulates TGFBR1 in glucocorticoid-inhibited osteoblast differentiation and ameliorates glucocorticoid-induced bone loss [J]. Int J Biol Sci, 2019, 15(10): 2182-2197.
[34] Colditz J, Thiele S, Baschant U, et al. Osteogenic Dkk1 mediates glucocorticoid-Induced but not arthritis-induced bone loss [J]. J Bone Miner Res, 2019, 34(7): 1314-1323.
[35] Farasat Zaman YZBC. Humanin is a novel regulator of Hedgehog signaling and prevents glucocorticoid-induced bone growth impairment [J]. FASEB J, 2019, 33(4): 4962-4974.

相关文章 15

[1]	杨庆婵,王咏梅,王承志. 急性纤维素性机化性肺炎3例病理特征及文献复习[J]. 山东大学学报 (医学版), 2023, 61(6): 58-64.
[2]	朱超,孙超,刘绪昌,夏大伟,马春骋,丰荣杰. 3D打印椎间融合器在37例单节段腰椎手术中的应用[J]. 山东大学学报 (医学版), 2023, 61(3): 134-140.
[3]	陈诗鸿,姜冬青,庄向华,李晓博,潘喆,孙爱丽,娄能俊,王殿辉,杜娇娇,宋玉文. 以骨痛为首发表现的原发性胆汁性胆管炎1例[J]. 山东大学学报 (医学版), 2022, 60(8): 98-102.
[4]	王洲洋,江蓓,李宪花,甄军晖,杨向东,胡昭,刘广义,裴斐. 感染性心内膜炎、急性肾损伤伴PR3-ANCA阳性患者1例报道[J]. 山东大学学报 (医学版), 2022, 60(2): 60-64.
[5]	刘萍,宋玉文,王萍,田光伟,郑凤杰,吕丽,杜娇娇,张静,庄向华,陈诗鸿. 维生素D缺乏与2型糖尿病合并抑郁状态的相关性[J]. 山东大学学报 (医学版), 2021, 59(6): 51-56.
[6]	邢小平. 原发性骨质疏松症诊治思考[J]. 山东大学学报 (医学版), 2021, 59(6): 1-4.
[7]	康成为,刘雷,蒲小兵,谭钢,董长超,晏兆魁. 合并亚临床型甲状腺功能减退的骨质疏松症62例患者骨代谢及骨转换标志物水平分析[J]. 山东大学学报 (医学版), 2020, 58(5): 82-86.
[8]	姬原原,包景泊,赵旭,曹鲁宁,崔敏,张娜,于灵芝. 白介素17F促进大鼠成骨细胞增殖、矿化和Runx2、Osterix的表达[J]. 山东大学学报（医学版）, 2017, 55(8): 24-29.
[9]	徐大霞,侯楠,李晓峰,王闯,孔猛,焦广俊,陈允震. 糖皮质激素性骨质疏松症骨代谢与糖皮质激素用药时间的相关性[J]. 山东大学学报（医学版）, 2017, 55(5): 103-107.
[10]	彭斐,宋玲,戚向敏,李亚芹,刁艳菲,钊守凤,王莉莉,杨芳,卢恕来,吕文芳,郭大伟. 间歇性张应力对小鼠破骨细胞TRPV5基因表达的影响[J]. 山东大学学报（医学版）, 2017, 55(11): 22-26.
[11]	吴倩,倪阳,杨清锐,孙红胜. 双眼睑肿胀及双侧颌下包块1例——IgG4相关性疾病的诊断与思考[J]. 山东大学学报（医学版）, 2017, 55(11): 93-96.
[12]	冯潇雨, 张洪美, 车选强, 康东红. 成骨细胞刺激因子对去卵巢骨质疏松大鼠的治疗效果[J]. 山东大学学报（医学版）, 2015, 53(7): 8-12.
[13]	刘海俊, 谢敏妍, 陈锦华, 冯洁萍, 邓振波. 替普瑞酮对大剂量激素治疗患者上消化道的保护作用[J]. 山东大学学报（医学版）, 2014, 52(S2): 57-58.
[14]	张岩. 某医院2014年上半年住院科室糖皮质激素使用情况调查分析[J]. 山东大学学报（医学版）, 2014, 52(S2): 108-111.
[15]	张丽, 严红. 2型糖尿病患者骨质疏松情况调查[J]. 山东大学学报（医学版）, 2014, 52(S2): 107-107.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed