類固醇引起之骨質疏鬆症

10.6666/ClinMed.202103_87(3).0030

顏憶寧；陳明翰

類固醇（glucocorticoid） ； 骨質疏鬆（osteoporosis） ； 骨折（fracture） ； FRAX骨折風險評估工具

臨床醫學月刊

87卷3期（2021 / 03 / 26）

186 - 191

繁體中文

因自體免疫疾病或肺部疾病，有時候患者必須使用類固醇。然而長期使用類固醇有可能增加骨質疏鬆的機會而導致骨折的風險上升。近年來醫界已注意到這個議題，倡導在開始使用類固醇時就應該審慎評估患者的骨折風險並給予適當的處置。我們建議先以骨密度掃描（dual energy x-ray absorptiometry, DXA）計算T score，並以fracture risk assessment tool（FRAX）來評估風險，值得注意的是，對使用類固醇的病人族群，其骨折風險必須加成。了解病人屬於高、中或低骨折風險族群後，就能針對不同族群予以預防。針對骨折風險較低的患者建議鈣質、維他命D3的補充，也能提倡做荷重運動、肌力訓練、避免菸酒等。若是屬於骨折高風險的病人則使用藥物治療，第一線治療包含雌激素受體調節劑、雙磷酸鹽、RANKL單株抗體。第二線可以使用副甲狀腺素衍生物等藥物。

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