당질코르티코이드성 골다공증 환자의 골절의 Paradox 와 부갑상선 호르몬의 특징적 변화

Objectives: The authors studied the relationship between patients who had fractures due to glucocorticoid induced osteoporosis and their conventionally measured bone mineral density. We also studied the charicteristic changes of parathyroid hormone in glucocorticoid induced osteoporosis. Methods: We analyzed 354patients with osteoporosis who had been taking Triamcinolone in doses greater than 2mg per day for 6months or more. BMD was measured by QCT and the fractures were diagnosed by lateral CT films. We measured the intact parathyroid hormone(intact PTH) by IRMA (Immunoradiometric assay). Results: In patients whose BMD measured 10 -69mg/Cm3, 35-80% had fractures. Patients with BMD in the range of 70-89mg/Cm3 showed a decreased percentage of fractures, while those with BMD over 140mg/Cm3 revealed an still remained percentage of fractures. The intact PTH averaged 42.3pg/ml in the 7th decade, 443pg/ml in the 8th decade, and 40.2pg/ml in the 9th decade. We couldn't find an increased level of intact PTH with aging. Patients with increased intact PTH levels of 90-99pg/ml and 110-119pg/ml, showed normal alkaline phosphatase levels of 77.7U/L and 66.0U/L respectively. We found one patient in the 5th decade, four in the 6th decade and three in the 7th decade, whose BMD according to their age was above normal range although their intact PTH levels were also above normal. Conclusion This study reveals that the BMD of trabecular vertebra measured by conventional QCT cannot show the histomorphometric stucture of the bone which is a major determining factor of in fractures. And the authors suggest that intact PTH donot increase in age dependant type II osteoporosis even when the patients were on glucocorticoids.