医学专题—系统性红斑狼疮的骨质疏松与皮质激素的相关性28028.ppt
![资源得分’ title=](/images/score_1.gif)
![资源得分’ title=](/images/score_1.gif)
![资源得分’ title=](/images/score_1.gif)
![资源得分’ title=](/images/score_1.gif)
![资源得分’ title=](/images/score_05.gif)
《医学专题—系统性红斑狼疮的骨质疏松与皮质激素的相关性28028.ppt》由会员分享,可在线阅读,更多相关《医学专题—系统性红斑狼疮的骨质疏松与皮质激素的相关性28028.ppt(51页珍藏版)》请在得力文库 - 分享文档赚钱的网站上搜索。
1、GC induced osteoporosis北京协和医院风湿(fnsh)免疫科张烜第一页,共五十一页。IntroductionnGCsareeffectiveinmanyrheumaticdiseasesnButGCinducedOPisacommonsideeffectnTrabecularrichsitesegspine&ribsareespeciallyatrisknEffectiveRxcanpreventorreverseGCboneloss第二页,共五十一页。OP in RA on GC Rxn多因素RAOsteoclast活化(TNFa,RANK)Physicalinactiv
2、ityGCRxMenopausen不同部位(bwi)骨丢失不同HandFemurSpine腰椎骨丢失与GC强相关第三页,共五十一页。PathophysiologynMostofthebiologicalactivitiesmediatedviaPassageacrosscellmembraneattachmenttocytosolicGCreceptorbindingtoGCresponseelement®ulatinggenetranscriptionnMayactviaothertranscriptionfactors:activatedprotein(AP)-1NFB第四页,共五十
3、一页。GC receptor&binding第五页,共五十一页。Effects of GC on bone metabolismnBoneformationMostimportantnBoneresorbtionProbablyonlyduring1st612monthsofRxOCproduction&postponedapoptosisLongterm,boneturnovernIntestinalabsorbtionofcalciumnUrinaryphosphate&calciumlossDirecteffectonkidneynSecondaryHyperparathyroidism
4、BonelossEarlybuttemporary第六页,共五十一页。Bone formationnMostimportantnDirecteffectsonosteoblastscellreplicationosteocyteapoptosistype1collagengeneexpressionnIndirecteffectssynthesis,release,receptorbindingorbindingproteinsofgrowthfactorsegIGFI&IIrelatedtosexsteroidproduction第七页,共五十一页。Effects of GC on bone
5、 metabolism第八页,共五十一页。EpidemiologynCommonnFirstrecognisedbyCushingnRiskofOPwithGCRxunclearReportedinupto50%onlongtermRxnFractureriskProspectivedatalackingRetrospectivecohortstudy244236ptsonGCRxvs244235controlpts(UKGPregistry)RRofvertebral#2.6,hip#1.6,nonvertebral#1.3Estimatedvertebralfractureincidenc
6、e1322%infirstyrofRxfromcalciumtreatedcontrolarmsofrecentrandomisedcontroltrialsCumulativeprevalenceofvertebralfractures:Upto28%(crosssectionalstudies)第九页,共五十一页。Factors associated with fracture risk with GC RxnAgenBMDInitial&subsequenttoGCRxPostmenopausalwomenhighestrisknGlucorticoiddoseCumulative&me
7、andailydosenDurationofexposurenUnderlyingdisease第十页,共五十一页。Relative Risk of Fracture第十一页,共五十一页。Risk factors for bone loss&fracturenRiskvariesaccordingtoage,dose&underlyingdiseasenThecaseforprimarypreventionisstrongestforpostmenopausalwomen&oldermenwithlowBMD第十二页,共五十一页。Bone Density&Fracture RisknInpos
8、tmenopausalwomenain1SDinBMDisassociatedwith2x#risknInptsonGCRxriskmaybegreateratlowerBMD第十三页,共五十一页。Dose,duration&formulation of Rx&Bone LossndoseGCRx(10mg/yr)vertebralboneloss5-10%/yrndoselowerrateofbonelossnBonelossmostrapidin1st612monthsofRxnGCbonelossappearsreversibleRxofCushingsnInhaledsteroidsl
9、esslikelytohavesystemiceffectsexceptathighdoses第十四页,共五十一页。InvestigationsnDEXAscannBiochemicalmarkersBoneformationegosteocalcinFallwithinafewhoursofRxBoneresorptionRiseafteracuteadministration第十五页,共五十一页。Treatment of GC OPnPrimarypreventionMostrapidbonelosswithin1st612monthsofRxnSecondaryprevention第十六
10、页,共五十一页。Prevention of GC-induced bone lossnUselowestdoseGCpossiblenMinimiselifestyleriskfactorssmokingnIndividualisedexerciseprogrammesnDrugRxCalciumVitaminD&metabolitesHRTBisphosphonatesPTHCalcitonin第十七页,共五十一页。Drug RxnBeneficialeffectsinspine&hipdemonstratedinspine&hipbyseveralinterventionsnPosthoc
11、/safetyanalysisoftrialsofetidronate,alendronate&residronatevertebralfractures第十八页,共五十一页。CalciumnGCintestinalcalciumabsorbtion&urinarycalciumexcretionnConflictingdataonefficacyinprimarypreventionnACR:Calciumintake(diet/suppl)10001500mg/d第十九页,共五十一页。Vitamin D active-metabolitesnCalcitriol(1,25dihydroxy
12、vitaminD)nAlfacalcidiol(1vitaminD)n1oprevention:BMDvsplacebon2oprevention:activevitDmetabolitesbetterthansimplevitDBMD/fracture/painRisk:hypercalcaemia&hypercalcuria第二十页,共五十一页。HRTn1controlledtrialinmenBMDwithtestosteronevscalciumn1randomisedcontroltrialinpostmenopausalwomenBMDwithoestrogenvscalciumn
13、NotrialsinpremenopausalwomennNofracturedatanReservedforptswithhormonedeficiency第二十一页,共五十一页。BisphosphonatesnboneresorbtionnMayGCinducedapoptosisofosteoblasts第二十二页,共五十一页。AlendronatenCombinedanalysisoftrials(477pts)vertebral/femoralneck/trochanter&wholebodyBMDPosthocanalysisofvertebralfracturesfavoured
14、Alendronateinpostmenopausalwomen第二十三页,共五十一页。第二十四页,共五十一页。RisedronatenPrimarypreventiontrial(224pts)Placebo+calciumvsRisedronateAfter1yr,BMDonRisedronateunchangedbutwithplaceboIncidenceofvertebralfractures17%withcalciumvs5.7%withRisedronate5mg(p=0.072)Vertebralfracturesseenonlyinpostmenopausalwomen&me
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 医学 专题 系统性红斑狼疮 骨质 疏松 皮质激素 相关性 28028
![提示](https://www.deliwenku.com/images/bang_tan.gif)
限制150内