MEDIX, God. 14 Br. 78  •  Pregledni članak  •  Reumatologija HR ENG

Patofiziologija osteoporoze s posebnim osvrtom na osteoporozu uzrokovanu glukokortikoidimaPathophysiology of osteoporosis with special regard to cortidosteroidinduced osteoporosis

Božidar Ćurković

Osteoporoza je skeletalni poremećaj karakteriziran smanjenom čvrstoćom kosti i povećanim rizikom za nastanak prijeloma. Koštana čvrstoća je određena koštanom gustoćom, veličinom kosti, strukturom i svojstvima materijala. U djetinjstvu i mladosti kost se modelira, a za postizanje vršne koštane mase uz genetske čimbenike važni su fizička aktivnost i prehrana. U zreloj dobi kost se remodelira, stara se resorbira i obnavlja novom u izbalansiranoj povezanosti. U osteoporozi taj je balans poremećen, veća je resorpcija od formacije, što rezultira gubitkom koštane mase. Gubitak kosti nastaje i zbog ubrzane frekvencije remodeliranja, čime slabi koštana struktura i čvrstoća kosti jer je proces formacije dulji od procesa resorpcije. Primjena nekih lijekova povezana je s povećanim rizikom za osteoporozu. Kronična terapija glukokortikoidima je najčešći razlog lijekovima uzrokovane osteoporoze. Glukokortikoidna osteoporoza predstavlja značajan problem zbog raširene upotrebe kortikosteroida u različitim bolestima, ali je još uvijek nedostatno dijagnosticirana i tretirana

Ključne riječi:
glukokortikosteroidi; osteoporoza; patofiziologija; pregradnja kosti

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Osteoporosis is a skeletal disorder characterised by reduced bone strength and increased risk of fractures. Bone strength is determined by bone density, bone size, structure and material properties. Bone is modelled during the childhood and adolescence, and peak bone mass is achieved in early adulthood. For achieving peak bone mass, physical activity and nutrition are as important as genetic factors. Throughout the adult age bone is remodelled: old bone is resorbed, and new bone is formed. In osteoporosis, the balance between these two processes is disrupted. Bone resorption becomes greater than bone formation, which leads to the loss of bone mass. Bone loss also occurs due to accelerated remodelling, with a consequent weakening of bone structure and strength, because bone formation process takes longer than bone resorption process. Some medications increase the risk of osteoporosis. Chronic corticosteroid therapy is the most frequent cause of medication-induced osteoporosis. Corticosteroid-induced osteoporosis is a significant problem due to a wide-spread use of corticosteroids in the therapy of various diseases. However, this disorder is still underdiagnosed and undertreated.

Key words:
bone remodelling; glucocorticoids; osteoporosis; pathophysiology