骨质疏松症已经成为现代社会中最为普遍的公共卫生问题之一。与之相关的骨折不仅可能引发严重的功能障碍和健康问题，还可能因骨折引发的并发症而导致死亡。此外，预计未来由骨质疏松症及其引发的骨折所造成的经济负担将会进一步加重。骨折的风险不仅受骨密度（BMD）的影响，还与多种影响骨强度的风险因素有关（表 1）[14]。 然而，在临床实践中，针对骨折预防的措施与理想状态仍存在一定的差距。有相应文献指出[16]：接受每日低于 2.5 mg 剂量的泼尼松龙治疗的患者，其骨折发生率预计将降低大约 20%。相对地，每日使用超过 7.5 mg 泼尼松龙治疗的患者，骨折风险预计将上升约 15%。至于那些每日服用 2.5 至 7.5 mg 泼尼松龙的个体，目前尚无证据表明其骨折风险有所改变。 因此，预防措施的提前主动实施并非唯一关键，激素的使用剂量亦是影响结果的重要因素。 ✩ 本文仅供医疗卫生等专业人士参考 策划 | 静姝投稿 | 503356829@qq.com题图 | 站酷海洛参考文献（上下滑动查看）1.Timmermans, S., Souffriau, J., & Libert, C. (2019). A General Introduction to Glucocorticoid Biology. Frontiers in immunology, 10, 1545. 2.李久旭. 地塞米松致医源性库欣综合征 1 例 [J]. 中国药物应用与监测,2020,17(05):347-349.3.刘岑, 赵紫楠, 陈頔, 等. 库欣综合征的诊疗进展 [J]. 罕见病研究,2024,3(02):187-194.4.He, X., Findling, J. W., & Auchus, R. J. (2022). Glucocorticoid Withdrawal Syndrome following treatment of endogenous Cushing Syndrome. Pituitary, 25(3), 393–403. 5.Wahab F, Rahman RA, Yaacob LH, Noor NM, Draman N. A Case Report of Steroid Withdrawal Syndrome. Korean J Fam Med. 2020 Sep;41(5):359-362. 6.Nachawi, N., Li, D., & Lansang, M. C. (2024). Glucocorticoid-induced adrenal insufficiency and glucocorticoid withdrawal syndrome: Two sides of the same coin. Cleveland Clinic journal of medicine, 91(4), 245–255. 7.Kavanaugh, A., & Wells, A. F. (2014). Benefits and risks of low-dose glucocorticoid treatment in the patient with rheumatoid arthritis. Rheumatology (Oxford, England), 53(10), 1742–1751. 8.中华医学会风湿病学分会, 痛风诊疗规范 (2023 年版)[J], 中华内科杂志,2023.62(9):1068-10769.Geer, E. B., Islam, J., & Buettner, C. (2014). Mechanisms of glucocorticoid-induced insulin resistance: focus on adipose tissue function and lipid metabolism. Endocrinology and metabolism clinics of North America, 43(1), 75–102. 10.Akalestou, E., Genser, L., & Rutter, G. A. (2020). Glucocorticoid Metabolism in Obesity and Following Weight Loss. Frontiers in endocrinology, 11, 59. 11.Strokotova, A. V., & Grigorieva, E. V. (2022). Glucocorticoid Effects on Proteoglycans and Glycosaminoglycans. International journal of molecular sciences, 23(24), 15678. 12.Beaupere, C., Liboz, A., Fève, B., Blondeau, B., & Guillemain, G. (2021). Molecular Mechanisms of Glucocorticoid-Induced Insulin Resistance. International journal of molecular sciences, 22(2), 623. 13.《二甲双胍临床应用专家共识》, 二甲双胍临床应用专家共识 (2023 年)[J], 中华内科杂志,2023,62(6):619-63014.Choi H. S. (2020). Why Do We Need Proactive Management for Fracture Prevention in Long-Term Glucocorticoid Users?. Endocrinology and metabolism (Seoul, Korea), 35(3), 549–551. 15.《中国老年骨质疏松症诊疗指南 (2023)》工作组, 中国老年骨质疏松症诊疗指南 (2023)[J], 中华骨与关节外科杂志,2023,16(10):865-88516.Lane N. E. (2019). Glucocorticoid-Induced Osteoporosis: New Insights into the Pathophysiology and Treatments. Current osteoporosis reports, 17(1), 1–7.
