Osteoporose Induzida por Corticóides

 

José Pedro Patrício, Patrícia Oliveira, Maria Teresa Faria, Maria Berta Pérez, Jorge Pereira

Serviço de Medicina Nuclear, Hospital de São João, Porto

 

Resumo

Os corticoesteróides são fármacos utilizados no tratamento de diversas patologias, pelas suas propriedades anti-inflamatórias e imunossupressoras. No entanto, secundariamente, produzem alterações importantes na fisiologia normal da remodelação óssea que predispõem à osteoporose. Os impactos de morbilidade e mortalidade da osteoporose são conhecidos. Os corticoesteróides são a causa mais comum de osteoporose secundária; contudo, vários estudos documentam uma má aplicação das recomendações internacionais na prevenção da osteoporose induzida por corticoesteróides. Este trabalho tem como objectivos rever a fisiopatologia da osteoporose induzida por corticoesteróides, esclarecer o papel da absorciometria radiológica de dupla energia no diagnóstico e monitorização terapêutica e referir os aspectos elementares da prevenção e tratamento destes doentes.

Palavras-chave: osteoporose; corticoesteróides; densitometria.

 

Corticosteroids Induced Osteoporosis

Abstract

Corticosteroids are widely used in the therapeutic of several pathologies because of their anti-inflammatory and immunossupresive effects. However, they interfere in normal physiology and bone remodeling, conducing to osteoporosis. The impacts of osteoporosis on morbidity and mortality are well known. Corticosteroids are the main cause of secondary osteoporosis; nevertheless, many studies document the incorrect use of international guidelines concerning the prevention of costicosteroid induced osteoporosis. The aim of this paper is to review the physiopathology of corticosteroid induced osteoporosis, to clarify the contribute of dual energy x-ray absorptiometry in the diagnosis and therapeutic monitoring, and to refer basic aspects of prevention and treatment of those patients.

Key-words: osteoporosis; corticosteroids; densitometry.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

REFERÊNCIAS

1 -Canhão H, Fonseca JE, Queiroz MV. Diagnóstico e terapêutica da osteoporose na idade pediátrica. Acta Méd Port 2004;17: 385-90.         [ Links ]

2 -Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D. Guidelines for Diagnosis and Management of Osteoporosis. Osteoporos Int 1997;7:390-406.

3 -Pinto Neto et al. Consenso brasileiro de osteoporose 2002. Rev Bras Reumatol 2002; vol. 42;nº6.

4 -Van Staa TP, Leufkens HGM, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fractures risk: relationship to dailyand cumulative doses. Rheumatology 2000;39:1383-9.

5 -Van Staa TP, Leufkens HGM, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 2002;13:777-87.

6 -Kanis JA et al. Assessment of fracture risk. Osteoporos Int 2005;16:581-9

7 -Gutiérrez-Polo R. Glucocorticoid-induced osteoporosis. An Sist Navar 2003;26:63-80.

8 -Gudbjornsson B, Juliusson UI, Gudjonsson FV. Prevalence of long term steroid treatment and the frequency of decision making to prevent steroid-induced osteoporosis in daily clinical practice. Ann Rheum Dis 2002;61:32-36.

9 -Casebeer L. Practice pattern variantion in prevention and treatment of osteoporosis. Curr Opin Rheumatol 2002;14: 453-7.

10 -Peat ID, Healy S, Reid DM, Ralston SH. Steroid induced osteoporosis: an opportunity for prevention? Ann Rheum Dis 1995;54:66-8.

11 -Walsh LJ, Wong CA, Pringle M, Tattersfield AE. Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ 1996;313:344-6.

12 -Van Staa TP, Leufkens GH, Abenhaim L, Begaud B, Zhang B, Cooper C. Use of oral corticosteroids in the United Kingdom. QJM 2000;93:105-11.

13 -Yood RA. Prevention of Glucocorticoid-Induced Osteoporosis: Why Are We Doing So Poorly? J Rheumatol 2006; 33:1461-3.

14 -Buckley LM, Marquez M, Hudson J, Downs RW, Vacek P, Small RE, et al. Variations in physicians’ judgments about corticosteroid induced osteoporosis by physician specialty. J Rheumatol 1998;25:2195-202.

15 -Borba VZC, Castro ML. Osteoporose induzida por glicocorticóide. Arq Bras Endocrinol Metab 1999;43/6: 452--45.

16 -Catherine B. Niewoehner, Dennis E. Niewoehner. Steroid-induced osteoporosis. Are your asthmatic patients at risk? Posgraduate Medicine [serial online] 1999 March; VOL 105 / NO 3. Disponível em URL: http://www.postgradmed.com/issues/1999/03_99/niewoehner.htm .

17 -Arlen DJ, Adachi JD. Are bisphosphonates useful in the management of corticosteroid induced osteoporosis in transplant patients? Jornal of Nephrology 1998;11:5-8.

18 -Ian R Reid. Glucocorticoid osteoporosis - mechanisms and management. European Journal of Endocrinology 1997; 137:209-217.

19 -Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990; 112:352-64.

20 -Weinstein RS, Jilka RL, Parfitt M, Manolagas SC. Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. J Clin Invest 1998;102:274-82.

21 -Francioni Lopes R, Fleiuss de Farias ML. Possibilidades Terapêuticas na Osteoporose Idiopática. Rev Bras Reumatol 2006;46:110-7.

22 -Bockman RS, Weinerman SA. Steroid-induced osteoporosis. Orthop Clin North Am 1990;21:97-107.

23 -Ureña P, Iida-Klein A, Kong X-F, Jüppner H, Kronenberg HM, Abou-Samra A-B, Segre GV. Regulation of parathyroid hormone (PTH) /PTH-related peptide receptor messenger ribonucleic acid by glucocorticoids and PTH in ROS 17/2.8 and OK cells. Endocrinology 1994;134:451-6.

24 -McSheehy PMJ, Chambers TJ. Osteoblastic cells mediate osteoclastic responsiveness to parathyroid hormone. Endocrinology 1986;118:824-8.

25 -Royal College of Physicians of London. Osteoporosis in-duced-glucocorticoids guidelines 2002.

26 -American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Arthritis Rheum 2001; 44:1496-503.

27 -Buckley LM. Clinical and diagnostic features of glucocorti-coid-induced osteoporosis. Clin Exp Rheumatol 2000; 18:S41-S43.

28 -Richard Eastell. Position statement on the reporting of dual energy x-ray absorptiometry (DXA) bone mineral density scans. National Osteoporosis Foundation 2002.

29 -Kanis JA, Melton LJ III, Christiansen C et al. The diagnosis of osteoporosis. J Bone Miner Res 1994;9:1137-41.

30 -Agarwal M, Camacho P. Symposium on osteoporosis. Bone densitometry. Posgraduate Medicine [serial online] June-July 2006;vol.119;nº1. Disponível em: URL: http://postgradmed.com/issues/2006/06/017/ .

31 -Queiróz MV. Reumatologia. Clínica e Terapêutica das Doenças Reumáticas II. Lisboa: Lidel; 2002.

32 -Gregório LH, Lacativa PGS, Melazzi ACC, Russo LAT. Osteoporose induzida por glicocorticóide. Arq Bras Endocrinol Metab 2006; vol.50; nº.4.

 

Correspondência:

Dr. José Pedro Patrício

Serviço de Medicina Nuclear

Hospital de São João

Alameda Prof. Hernâni Monteiro 4200-319 Porto

e-mail: josepedropatricio@gmail.com