3. Glucocorticoid-Induced Osteoporo

3. Glucocorticoid-Induced Osteoporosis
Glucocorticoids play a significant role in bone remodeling. Exogenous glucocorticoid administration results in an increase in bone resorption, inhibition of bone formation, and change in bone quality. Glucocorticoids such as prednisone, hydrocortisone, methylprednisolone, and dexamethasone promote bone resorption through reduced calcium absorption from the gastrointestinal tract and increased renal calcium excretion. Bone formation is reduced through inhibition of osteoblasts. They also decrease estrogen and testosterone production. Patients receiving long-term glucocorticoids are at increased risk of fracture. This risk is greater with higher doses and longer-term therapy. Most bone is lost during the initial 6 to 12 months of therapy, and bone mass continues to decline thereafter. Owing to the risk of bone loss and fractures, therapy is recommended for patients receiving long-term supraphysiologic doses of glucocorticoids. In addition to nonpharmacologic measures, the American College of Rheumatology (ACR) has specific recommendations for prevention and treating patients receiving glucocorticoids. Recommendations for optimal calcium and vitamin D intake are higher among patients receiving glucocorticoids. These recommendations include 1500 mg daily of elemental calcium and 800 IU daily of vitamin D for all adults receiving glucocorticoids. Patients should take a vitamin D–containing supplement to ensure that these requirements are being met.

The ACR recommends bisphosphonate therapy for all patients who are starting treatment with glucocorticoids (prednisone greater than or equal to 5 mg daily or equivalent) that will continue for 3 months or longer. For patients receiving chronic glucocorticoids (prednisone greater than or equal to 5 mg daily or equivalent), bisphosphonate therapy is also recommended if the bone mineral density is low or there is a history of fracture. Calcitonin may be used in patients who are intolerant of bisphosphonates.

The ACR recommends bisphosphonate therapy for all patients who are starting treatment with glucocorticoids (prednisone greater than or equal to 5 mg daily or equivalent) that will continue for 3 months or longer. For patients receiving chronic glucocorticoids (prednisone greater than or equal to 5 mg daily or equivalent), bisphosphonate therapy is also recommended if the bone mineral density is low or there is a history of fracture. Calcitonin may be used in patients who are intolerant of bisphosphonates.

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3. diinduksi glukokortikoidGlukokortikoid memainkan peran penting dalam remodeling tulang. Administrasi eksogen glukokortikoid mengakibatkan peningkatan resorpsi tulang, penghambatan pembentukan tulang, dan perubahan dalam kualitas tulang. Glukokortikoid seperti prednison, hidrokortison, methylprednisolone, dan deksametason mempromosikan resorpsi tulang melalui penyerapan kalsium berkurang dari saluran pencernaan dan ekskresi kalsium ginjal meningkat. Pembentukan tulang berkurang melalui penghambatan osteoblas. Mereka juga mengurangi produksi estrogen dan testosteron. Pasien yang menerima glukokortikoid jangka panjang berada pada peningkatan risiko fraktur. Risiko ini lebih besar dengan dosis tinggi dan terapi jangka panjang. Sebagian tulang hilang selama 6-12 bulan awal terapi, dan tulang massa terus menurun sesudahnya. Karena risiko kehilangan tulang dan patah tulang, terapi dianjurkan untuk pasien yang menerima dosis supraphysiologic jangka panjang glukokortikoid. Selain langkah-langkah nonpharmacologic, American College of Rheumatology (ACR) memiliki rekomendasi khusus untuk pencegahan dan merawat pasien menerima glukokortikoid. Rekomendasi untuk asupan kalsium dan vitamin D yang optimal lebih tinggi di antara pasien yang menerima glukokortikoid. Rekomendasi ini termasuk 1500 mg sehari elemental kalsium dan 800 IU vitamin D setiap hari untuk semua orang dewasa yang menerima glukokortikoid. Pasien harus mengambil suplemen yang mengandung vitamin D-untuk memastikan bahwa persyaratan tersebut terpenuhi.The ACR recommends bisphosphonate therapy for all patients who are starting treatment with glucocorticoids (prednisone greater than or equal to 5 mg daily or equivalent) that will continue for 3 months or longer. For patients receiving chronic glucocorticoids (prednisone greater than or equal to 5 mg daily or equivalent), bisphosphonate therapy is also recommended if the bone mineral density is low or there is a history of fracture. Calcitonin may be used in patients who are intolerant of bisphosphonates.

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