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目的为获得预防糖皮质激素所致骨质疏松的最有效方法,用循证医学的方法检索和评价目前可获得的最佳证据。方法计算机检索ACPJournalClub(1991-01~2005-09)、美国AHRQ证据报告、Co-chrane图书馆(2005年第3期)和MEDLINE(1990-01~2005-09),查找预防糖皮质激素所致骨质疏松的系统评价、临床随机对照试验、卫生经济学评价等,并对所获证据质量进行评价。结果目前最佳的临床证据表明,预防性使用维生素D或其活性类似物加钙、双磷酸盐等能确切提高糖皮质激素所致骨质疏松者的骨密度。现有证据显示各类药物对骨折的减少作用没有统计学意义。结论维生素D或其活性类似物加钙是长期服用糖皮质激素患者预防骨质疏松的首选药物,双磷酸盐也是可选药物。
OBJECTIVE To obtain the most effective method available to prevent glucocorticoid-induced osteoporosis, evidence-based medicine was used to retrieve and evaluate the best available evidence so far available. Methods A computer-based search of ACPJournalClub (1991-01 ~ 2005-09), US AHRQ evidence report, Co-chrane Library (2005) and MEDLINE (1990-01 ~ 2005-09) Systematic evaluation of osteoporosis, clinical randomized controlled trials, evaluation of health economics, etc., and evaluate the quality of evidence obtained. Results The best clinical evidence shows that prophylactic use of vitamin D or its active analogues such as calcium and bisphosphonates can definitely increase the bone density of those with osteoporosis caused by glucocorticoids. The available evidence shows that all kinds of drugs have no significant effect on the reduction of fractures. Conclusions Vitamin D or its active analogue plus calcium is the first choice of medicine for long-term use of glucocorticoid to prevent osteoporosis. Bisphosphonates are also an option.