GCinducedosteoporosis风湿免疫科IntroductionOPinRAonGCRxPathophysiologyGCreceptor&bindingEffectsofGConbonemetabolismBoneformationEffectsofGConbonemetabolismEpidemiologyFactorsassociatedwithfractureriskwithGCRxRelativeRiskofFractureRiskfactorsforboneloss&fractureBoneDensity&FractureRiskDose,duration&formulationofRx&BoneLossInvestigationsTreatmentofGCOPPreventionofGC-inducedbonelossDrugRxCalciumVitaminDactive-metabolitesHRTBisphosphonatesAlendronateRisedronatePTHCalcitoninThiazidediuretics&saltrestrictionGIOP干预措施实施时机GIOP--ACRGuideline(1)long-termGC(equivalentof5mg/day):纠正对OP不良的生活习惯停止或少吸烟减少过度饮酒负重体育锻炼指导开始补钙开始补充VitD(plainoractivatedform).如缺乏或有临床指征---HRT测定腰椎和/或髋关节BMD.IfBMDabnormal(i.e.,T-scorebelow-1)－－BPT(绝经期前妇女使用小心).BPT有禁忌或不能耐受－－calcitoninIfBMDisnormal－－随诊，每年或每两年复查BMD.Guideline－－英国（BoneandToothSocietyofGreatBritain,theNationalOsteoporosisSocietyandtheRoyalCollegeofPhysicians）Guideline－－英国（BoneandToothSocietyofGreatBritain,theNationalOsteoporosisSocietyandtheRoyalCollegeofPhysicians）Guideline－－英国（BoneandToothSocietyofGreatBritain,theNationalOsteoporosisSocietyandtheRoyalCollegeofPhysicians）DrugRxGuideline－－英国（BoneandToothSocietyofGreatBritain,theNationalOsteoporosisSocietyandtheRoyalCollegeofPhysicians）GIOP--BelgiumGuidelineGIOP--BelgiumGuidelineCaandVitDGIOP--BelgiumGuidelineCaandVitD系统性红斑狼疮的骨质疏松与皮质激素的相关性研究对象骨质疏松的诊断按世界卫生组织1994年提出的标准：（1）骨密度值低于正常年轻人峰值2.5个标准差（s）为骨质疏松；（2）骨密度值在正常年轻人峰值以下1.0～2.5s之间为骨量减少。方法表1激素疗程对骨密度的影响(±s)