Abstract：
Objective Although patients with neuroimmunological disorders often need to be treated with glucocorticoids and are at risk of developing glucocorticoid-induced osteoporosis, no research has focused on the treatment of glucocorticoid-induced osteoporosis in such patients. Methods We compared the efficacy of denosumab and bisphosphonates in glucocorticoid-induced osteoporosis in neuroimmunological diseases. In 57 patients with neuroimmunological disorders treated with corticosteroids (34 with neuromyelitis optica spectrum disorders, 16 with myasthenia gravis, and 7 with others), we retrospectively studied the long-term effects of denosumab (n=23) and bisphosphonates (n=34) on spine and total hip bone mineral density (BMD) measured by dual energy X-ray absorptiometry. Results There were no significant differences in the age, lumbar spine BMD, or mean dose or duration of prednisolone administration at baseline between the denosumab and bisphosphonate groups. During the follow-up period of up to 6 years, the increase in the lumbar spine and total hip BMD was greater in the denosumab group than in the bisphosphonate group (p<0.01). Insufficient bone fractures were observed in 2 (9%) of the 23 patients in the denosumab group and in 2 (6%) of the 34 patients in the bisphosphonate group (not significant). Conclusion Denosumab is more effective than bisphosphonates in increasing the BMD of patients with neuroimmunological disorders receiving glucocorticoids.
摘要：
目的虽然神经免疫疾病的患者往往需要接受糖皮质激素治疗，并且存在发生糖皮质激素诱导的骨质疏松的风险。目前还没有研究关注糖皮质激素诱导的骨质疏松患者的治疗.方法我们比较了地诺单抗和双膦酸盐在神经免疫疾病中糖皮质激素诱导的骨质疏松症中的疗效。在57例接受皮质类固醇治疗的神经免疫疾病患者中（34例患有视神经脊髓炎谱系疾病，16患有重症肌无力，和7与其他人)，我们回顾性研究了通过双能X线吸收法测量的地诺单抗(n=23)和双膦酸盐(n=34)对脊柱和全髋骨矿物质密度(BMD)的长期影响.结果两组患者年龄差异无统计学意义,腰椎BMD,或在基线时替诺塞麦和双膦酸盐组之间的泼尼松龙给药的平均剂量或持续时间。在长达6年的随访期间，denosumab组腰椎和全髋部BMD的增加大于双膦酸盐组（p<0.01）。在denosumab组的23例患者中有2例（9％）和在双膦酸盐组的34例患者中有2例（6％）观察到骨折不足（不明显）。结论Denosumab在增加接受糖皮质激素的神经免疫障碍患者的BMD方面比二膦酸盐更有效。
