骨鬆痛錯當風濕痛？ 風濕免疫疾患小心骨鬆

[MK]

http://tw.news.yahoo.com/article/url/d/ ... 1lafy.html
更新日期:2009/06/15 14:52 【中時健康 陳怡君／台北報導】
很多人都以為骨質疏鬆症是沉默的疾病，但其實骨鬆也會引起疼痛症狀，一名六十幾歲的婦人，因為罹患類風溼性關節炎多年，日前覺得腰椎疼痛越來越嚴重，以為是風濕疾病發作，趕緊找醫師，經檢查才知道是骨鬆造成腰椎部位骨折所導致。

台北榮總內科部過敏免疫風濕科主治醫師蔡長祐表示，一般風濕免疫疾病的女性患者多位於50-60歲，也多是停經後的婦女，因為荷爾蒙減少骨質容易流失，加上這類疾病屬於慢性發炎反應，會刺激「破骨細胞」的活性，再次加速骨質流失的速度，因此風濕免疫疾病患者也是骨鬆的高危險群。

此外，風濕免疫疾病的患者常需長年服用類固醇來抑制發炎反應，可是類固醇同時也會抑制製造骨頭的造骨細胞活性，成為骨質流失的幕後推手。據估計，使用口服類固醇超過六個月以上，約有五成的患者會引發骨質疏鬆症，而使用類固醇的患者比一般人發生骨折的機率多出三倍。

蔡長祐指出，這類患者除了要治療風濕免疫疾病，也應積極注意骨鬆問題，一旦疏於防範而造成骨折導致終身臥床，生活品質將大受影響。目前常見治療骨鬆的藥物包括雌激素受體調節劑、雙磷酸鹽類藥物或是副甲狀腺素等等，在臨床上都有不錯的成效。雌激素受體調節劑可用於預防或治療停經後的骨鬆婦女，雙磷酸鹽類藥物可抑制蝕骨細胞的活性，來達到治療骨鬆的效果，兩者主要是透過防止骨質流失的方式，來增加骨密度，減少骨折。至於副甲狀腺素是屬於造骨促進劑，是目前骨鬆藥物中，唯一可藉由促進造骨細胞的活性，刺激骨頭重新生長來增加骨密度，進而修復骨頭汰舊換新的機制，不過一般建議治療期限不得超過18個月。

骨骼細胞的新陳代謝，是破骨細胞和造骨細胞的相互作用維持平衡，才會有良好骨骼品質，蔡長祐提醒，良好的骨品質和骨密度，才能提升骨強度，避免二次骨折的風險，根據國外研究指出，尤其針對嚴重的骨鬆患者，促進造骨細胞的治療將更能達到降低骨折風險的效果。

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