2022年医学专题—系统性红斑狼疮的骨质疏松与皮质激素的相关性(1).pptVIP免费

GCinducedosteoporosis北京协和医院风湿(fēnshī)ɡ免疫科张烜第一页，共五十一页。Introduction第二页，共五十一页。OPinRAonGCRx多因素RA•Osteoclast活化(TNFa，RANK)PhysicalinactivityGCRx第三页，共五十一页。PathophysiologyMostofthebiologicalactivitiesmediatedviaPassageacrosscellmembraneattachmenttocytosolicGCreceptorbindingtoGCresponseelement®ulatinggenetranscription第四页，共五十一页。GCreceptor&binding第五页，共五十一页。EffectsofGConbonemetabolismBoneformationMostimportantBoneresorbtionProbablyonlyduring1st6–12monthsofRxOCproduction&postponedapoptosisLongterm,boneturnover第六页，共五十一页。BoneformationMostimportantDirecteffectsonosteoblastscellreplicationosteocyteapoptosistype1collagengeneexpressionIndirecteffects第七页，共五十一页。EffectsofGConbonemetabolism第八页，共五十一页。EpidemiologyCommonFirstrecognisedbyCushingRiskofOPwithGCRxunclearReportedinupto50%onlongtermRxFractureriskProspectivedatalackingRetrospectivecohortstudy•244236ptsonGCRxvs244235controlpts(UKGPregistry)•RRofvertebral#2.6,hip#1.6,nonvertebral#1.3第九页，共五十一页。FactorsassociatedwithfractureriskwithGCRx第十页，共五十一页。RelativeRiskofFracture第十一页，共五十一页。Riskfactorsforboneloss&fractureRiskvariesaccordingtoage,dose&underlyingdiseaseThecaseforprimarypreventionisstrongestforpostmenopausalwomen&oldermenwithlowBMD第十二页，共五十一页。BoneDensity&FractureRisk第十三页，共五十一页。Dose,duration&formulationofRx&BoneLossdoseGCRx(10mg/yr)vertebralboneloss5-10%/yrdoselowerrateofbonelossBonelossmostrapidin1st6–12monthsofRxGCbonelossappearsreversibleRxofCushing’s第十四页，共五十一页。Investigations•FallwithinafewhoursofRx•Riseafteracuteadministration第十五页，共五十一页。TreatmentofGCOP第十六页，共五十一页。PreventionofGC-inducedbonelossUselowestdoseGCpossibleMinimiselifestyleriskfactorssmokingIndividualisedexerciseprogrammesDrugRxCalciumVitaminD&metabolites第十七页，共五十一页。DrugRx第十八页，共五十一页。Calci...