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R. Gutiérrez-Polo (2003)
Publisher: Gobierno de Navarra. Departamento de Salud
Journal: Anales del Sistema Sanitario de Navarra
Languages: Spanish
Types: Article
Subjects: Osteoporosis, Glucocorticoides, Fracturas osteoporóticas, Osteoporosis, Glucocorticoids, Osteoporotic fracture, Public aspects of medicine, RA1-1270, Medicine, R, DOAJ:Public Health, DOAJ:Health Sciences
Los glucocorticoides son un grupo de fármacos que se emplean muy frecuentemente en la práctica médica por su indiscutible utilidad. La osteoporosis inducida por éstos supone el principal efecto adverso derivado de su administración sistémica y prolongada, constituyendo la causa más frecuente de osteoporosis secundaria. Comporta además una importante repercusión sanitaria y socioeconómica como consecuencia de las complicaciones que ocasiona, como son las diferentes fracturas óseas por fragilidad, sobre todo vertebrales, y la discapacidad funcional resultante. Se produce de forma temprana, siendo más rápida la pérdida ósea en los meses siguientes a la instauración de dicha terapia, en relación fundamentalmente con la dosis diaria. La patogenia de este tipo de osteoporosis es multifactorial, pero destaca el efecto inhibidor que presentan los glucocorticoides sobre la formación ósea. El manejo adecuado de este serio problema de salud requiere una actitud activa, que sin embargo no es lo suficientemente óptima en la actualidad. Incluye inicialmente las mismas medidas diagnósticas, preventivas y terapéuticas disponibles para otros casos de osteoporosis, pero con ciertas matizaciones y particularidades, especialmente las concernientes al propio manejo de los corticosteroides. Es conveniente un plan multidisciplinar, que se ha mostrado efectivo, principalmente si se realiza de forma temprana desde el inicio de la terapia. No obstante, quedan aún muchas cuestiones por esclarecer tanto en aspectos referentes a la corticoterapia, en general, como a la osteoporosis ocasionada, en particular. Es necesario el estudio y la búsqueda de nuevas terapias que mejoren la efectividad conseguida con las actuales para minimizar las repercusiones adversas que tiene para la salud de estos enfermos la administración de glucocorticoides.
Glucocorticoids are a group of drugs widely used in medical practice due to their unquestionable utility. Corticoid-induced osteoporosis is the main adverse event deriving from their systemic and long-term administration, being the most frequent cause of secondary osteoporosis. This implies an important health and socio-economic repercussion due to the complications it causes, such as fragility fractures, above all of vertebral origin, and the resultant functional incapacity. The bone loss is produced early, being greatest in the first few months of glucocorticoid use, in relation fundamentally to daily dose. The pathogenesis of this type of osteoporosis is multifactorial, but the inhibitory effect of corticoids on bone formation can be emphasised. The adequate management of this serious health problem requires an active attitude that is currently suboptimal. It involves similar diagnostic, preventive and therapeutic recommendations available for other, different causes of bone loss, but with certain particularities, especially including those referring to the self-management of corticosteroids. A multidisciplinary strategy is advisable, which has shown its effectiveness, mainly if it is carried out early, from the start of glucocorticoid therapy. Nevertheless, there are many questions to be clarified about aspects relating to therapy with corticosteroids in general, and to the osteoporosis caused by them in particular. What is needed is the evaluation and investigation of new treatments that will improve the effectiveness obtained with those in current use, in order to minimize the adverse consequences that glucocorticoid use has for the health of patients.

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