پیامدهای مصرف طولانی مدت داروهای کورتیکواسترویید بر سیستم اسکلتی عضلانی(مقاله مروری)

نوع مقاله : مروری

نویسندگان

1 دانشگاه علوم پزشکی تهران،دستیار فلوشیپ زانو،مرکز تحقیقاتی تعویض مفصل زانووهیپ بیمارستان امام خمینی تهران

2 دانشگاه علوم پزشکی تهران،بیمارستان امام خمینی ،مرکز تحقیقات تعویض مفاصل

3 دنشیار گروه ارتوپدی دانشگاه علوم پزشکی تهران،بیمارستان امام خمینی تهران،مرکز تحقیقات تعویض مفاصل

4 استادیار دانشگاه علوم پزشکی تهران،بیمارستان امام خمینی تهران،مرکز تحقیقات تعویض مفاصل

5 دستیار تخصصی ارتوپدی دانشگاه علوم پزشکی تهران،بیمارستان امام خمینی تهران،مرکز تحقیقات تعویض مفاصل

6 استاد دانشگاه علوم پزشکی تهران،بیمارستان امام خمینی تهران،مرکز تحقیقات تعویض مفاصل

چکیده
چکیده:
کورتیکواستروئیدها داروهای پرکاربردی هستند که مصرف آن‌ها در حال افزایش است. در بیماری‌های خودایمنی و روماتولوژی، استفاده از کورتیکواستروئیدها به صورت پالس درمانی و طولانی‌مدت بسیار رایج است و به دلیل پاندمی کووید-۱۹، مصرف آن‌ها افزایش چشمگیری یافته است. بااین‌حال، مصرف طولانی‌مدت کورتیکواستروئیدها می‌تواند با عوارض جانبی متعددی بر سیستم اسکلتی-عضلانی همراه باشد، از جمله استئوپروز، افزایش خطر شکستگی‌، نکروز آواسکولار، هیپوکلسمی، هیپوویتامینوز D و اختلال در رشد استخوان در کودکان. استئوپروز ناشی از کورتیکواستروئیدها شایع‌ترین نوع پوکی استخوان ثانویه است. چندین عامل مانند سن، مدت‌زمان مصرف، سابقه خانوادگی پوکی استخوان، شکستگی‌های قبلی و میزان دریافت کلسیم در شیوع آن نقش دارند. کورتیکواستروئیدها اثرات خود را با اختلال در تعادل بین عملکرد سلول‌های استئوبلاست و استئوکلاست اعمال می‌کنند. این داروها همچنین با تغییر در جذب کلسیم از روده و دفع کلسیم از طریق کلیه‌ها، متابولیسم کلسیم را مختل می‌کنند. برای به حداقل رساندن این عوارض، می‌بایست درمان با کورتیکواستروئید در صورت امکان محدود شود-با مصرف مکمل‌های کلسیم و ویتامین D همراه باشد، ایجاد وقفه‌های حداقل سه‌ماهه بین دوره‌های مصرف کورتیکواستروئید و در نظر داشتن درمان‌های جایگزین (به‌ویژه در اطفال) می‌تواند به کاهش خطرات احتمالی کمک کند.

کلیدواژه‌ها

موضوعات

عنوان مقاله English

Musculoskeletal Side Effects Associated with Long-Term Corticosteroid Use(Review Article)

نویسندگان English

abdolsalam razzaghi 1
sina esmaeili 2
mohammad Ayati Firoozabadi 3
pouya Tabatabaei Irani 4
hamed naghizade 5
Seyed Mohammad Javad Mortazavi 6
1 Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Department of Orthopedic Surgery, Imam Khomeini Hospital Complex
2 Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Department of Orthopedic Surgery, Imam Khomeini Hospital Complex
3 Associate Professor of Orthopedic Surgery ,Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran,1. Joint Reconstruction Research Center
4 Assistant Professor of Orthopedic Surgery ,Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran,1. Joint Reconstruction Research Center
5 Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Joint Reconstruction Research Center
6 Professor of Orthopedic Surgery ,Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran,1. Joint Reconstruction Research Center
چکیده English

Abstract
Corticosteroids are widely used medications with increasing prevalence in clinical practice. In autoimmune and rheumatological diseases, the use of corticosteroids in both pulsed and long-term manners is very common. Due to the COVID-19 pandemic, their consumption increased. However, long-term use is associated with several adverse effects on the musculoskeletal system, including osteoporosis, an elevated risk of fracture, avascular necrosis, hypocalcemia, hypovitaminosis D, and impaired bone growth in children. Corticosteroid-induced osteoporosis is the most common form of secondary osteoporosis. Several factors, such as age, time of use, family history of osteoporosis, previous fractures, and calcium intake, contribute to its prevalence. Corticosteroids exert their effects by disrupting the balance between the activity of osteoblasts and osteoclasts. These medications also disturb the calcium metabolism by altering intestinal calcium absorption and renal calcium excretion. To minimize these side effects, corticosteroid therapy should be limited whenever possible. Also, supplementing with calcium and vitamin D, incorporating breaks of at least three months between corticosteroid courses, and considering alternative therapies, especially in pediatric patients, can help mitigate the potential risks.

کلیدواژه‌ها English

Corticosteroids
Osteoporosis
Musculoskeletal system
Drug side effects
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