Sistematik Kortikosteroid Kullanımında D Vitamini Desteği
Özet
Sistemik kortikosteroidler (KS), inflamatuar ve otoimmün hastalıkların tedavisinde yaygın olarak kullanılan etkili ajanlardır. Adrenal korteksteki doğal hormonların sentetik analogları olan bu ilaçlar; antiinflamatuar, immünsupresif, antiproliferatif ve vazokonstriktör etkilere sahiptir. Ancak uzun süreli ve suprafizyolojik dozlarda kullanımları, başta osteoporoz, kemik kaybı, osteonekroz ve kırık riskinde artış olmak üzere ciddi yan etkilere yol açar. KS'ler, osteoblastları inhibe ederek kemik oluşumunu azaltırken, bağırsaktan kalsiyum emilimini düşürür ve idrarla atılımını artırır. D vitamini ise bağırsaktan kalsiyum emilimini uyararak ve paratiroid hormonu salgılanmasını azaltarak kemik mineral metabolizmasını düzenler. Yapılan klinik araştırmalar ve meta-analizler, KS tedavisi alan hastalarda kalsiyum ve D vitamini takviyesinin kemik kaybını önlemede ve kırık riskini azaltmada tek başına kalsiyum kullanımına kıyasla daha etkili olduğunu göstermektedir. Mevcut kılavuzlar, 3 aydan uzun süre herhangi bir dozda sistemik kortikosteroid kullanan yetişkin hastalara, osteoporozu önlemek amacıyla yaşam tarzı değişikliklerinin yanı sıra günlük 1.200-1.500 mg kalsiyum ve 800-1.000 IU D vitamini desteği almalarını önermektedir.
Systemic corticosteroids (CS) are effective agents widely used in the treatment of inflammatory and autoimmune diseases. Being synthetic analogs of natural hormones in the adrenal cortex, these drugs possess anti-inflammatory, immunosuppressive, antiproliferative, and vasoconstrictor effects. However, their long-term use at supraphysiological doses leads to serious side effects, particularly osteoporosis, bone loss, osteonecrosis, and an increased risk of fractures. CS induce bone loss by reducing bone formation through the inhibition of osteoblasts, while decreasing calcium absorption from the intestines and increasing its urinary excretion. Vitamin D regulates bone mineral metabolism by stimulating calcium absorption from the intestines and reducing parathyroid hormone secretion. Clinical studies and meta-analyses demonstrate that calcium and vitamin D supplementation in patients receiving CS therapy is more effective in preventing bone loss and reducing fracture risk compared to the use of calcium alone. Current guidelines recommend that adult patients using systemic corticosteroids at any dose for longer than 3 months receive 1,200-1,500 mg of daily calcium and 800-1,000 IU of vitamin D supplementation, alongside lifestyle modifications, to prevent osteoporosis.
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