臨床整形外科49巻9号

2014年09月発行

誌上シンポジウム 骨粗鬆症に対する治療戦略

ステロイド性骨粗鬆症の管理と治療ガイドライン改訂に向けて

著者： 鈴木康夫¹

所属機関： ¹東海大学医学部リウマチ内科

ページ範囲：P.787 - P.795

　10年ぶりに改訂されたステロイド性骨粗鬆症(GIO)の管理と治療ガイドラインは，国内のGIOのコホートの解析により独自の骨折危険因子を抽出して，初めてスコア法を薬物療法開始の基準判定に導入した．すなわち，1,047例の解析により得られた骨折予測因子である既存骨折，年齢，ステロイド投与量(mg/日)，腰椎骨密度をカテゴリー化しスコアを与え，症例ごとの骨折リスクを総スコアで評価する．スコア3以上であれば薬物療法の適応とした．薬物療法の推奨は，骨密度減少と骨折の抑制効果があり，かつ1次予防と2次予防の両者において有効性が確認されているアレンドロネートとリセドロネートが第1選択薬として推奨された．

参考文献

1) Amin S, Lavalley MP, Simms RW, et al:The comparative efficacy of drug therapies used for the management of corticosteroid-induced osteoporosis:A meta-regression. J Bone Miner Res 17:1512-1526, 2002

2) Cohen SL, Levy RM, Keller M, et al:Risedronate therapy prevents corticosteroid-induced bone loss:a twelve month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 42:2309-2318, 1999

3) de Nijs RN, Jacob JW, Algra A, et al:Prevention and treatment of glucocorticoid-induced osteoporosis with active vitamin D3 analogues:a review with meta-analysis of randomized controlled trials including organ transplantation studies. Osteoporosis Int 15:589-560, 2004

4) Grossman JM, Gordon R, Ranganath VK, et al:American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res 62:1515-1526, 2010

5) Kanis JA:On behalf of the World Health Organization Scientific Group. Assessment of Osteoporosis at the Primary Health Care Level. WHO Collaborating Centre for Metabolic Bone Diseases. University of Scheffield, 2007

6) Kirigaya D, Nakayama T, Ishizuka T, et al:Management and treatment of osteoporosis in patients receiving long-term glucocorticoid treatment:current status of adherence to clinical guidelines and related factors. Intern Med 50:2793-2800, 2011

7) Lekamwasam S, Adachi JD, Agnusdei D, et al:A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporosis Int 23:2257-2276, 2012

8) Nawata H, Soen S, Takayanagi R, et al:Guidelines on the management and treatment of glucocorticoid- induced osteoporosis of the Japanese Society for Bone and Mineral Research (2004). J Bone Miner Met 23:105-109, 2005

9) Ringe JD, Dorst A, Faber M, et al:Intermittent intravenous ibandronate injections reduce vertebral fracture risk in corticosteroid-induced osteoporosis:results from long-term comparative study. Osteoporosis Int 14:801-807, 2003

10) Saag KG, Emkey R, Schnitzer JJ, et al:Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-Induced Osteoporosis Intervention Study Group. N Engl J Med 339:292-299, 1998

11) Saag KG, Shane E, Boonen S, et al:Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med 357:2028-39, 2007

12) Saag KG, Zanchetta JR, Devogelaer JP, et al:Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis:thirty-six-month results of a randomized, double-blind, controlled trial. Arthritis Rheum 60:3346-3355, 2009

13) Suzuki Y, Nawata H, Soen S, et al:Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research:2014 update. J Bone Miner Metab 32:337-350, 2014 DOI 10.1007/s00774-014-0586-6, 2014

14) Stoch SA, Saag SA, Greenwald M, et al:Once-weekly oral alendronate 70 mg in patients with glucocorticoid-induced bone loss:a 12-month randomized, placebo-controlled clinical trial. J Rheumatol 36:1705-1714, 2009

15) The Ad Hoc Committee to develop Guidelines for Prevention and Treatment of Osteoporosis (The Japanese Society of Bone and Mineral Research/The Japanese Society of Osteoporosis Collaborative Initiative.) (2011) Guidelines for Prevention and Treatment of Osteoporosis. 2011 Edition. Life Science, Tokyo, 2011

16) Van Staa TP, Leufkens HG, Cooper C:The epidemiology of corticosteroid-induced osteoporosis:a meta-analysis. Osteoporosis Int 13:777-787, 2002

17) Van Staa TP, Laan RF, Barton IP, et al:Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 48:3224-3229, 2003