腎と骨代謝 Vol.23 No.4(5)


特集名 関節リウマチと骨代謝
題名 関節リウマチにおける骨粗鬆症・insuffi ciency fracture
発刊年月 2010年 10月
著者 橋本 淳 大阪大学大学院医学系研究科器官制御外科学(整形外科)
【 要旨 】 関節リウマチ(RA)に伴う二次性骨粗鬆症では,全身のさまざまな部位に骨折をきたすことと,X線像上捉えにくいinsufficiency fractureの様式をとることが多い点で,原発性骨粗鬆症やステロイド性骨粗鬆症とは異なる臨床像を呈する.またRA患者は骨折により歩行障害に至る例も多い.このような骨折に伴う患者の不利益に対して的確に対応し,また骨折に伴う機能障害を生じないようなRAの治療戦略を病初期より考えながら治療することが大切である.それゆえここでは,insuffi ciency fractureの診断の重要性とinsuffi ciency fracture診断のコツを記載した.
Theme Bone metabolism in rheumatoid arthritis
Title Osteoporosis and insufficiency fractures in rheumatoid arthritis
Author Jun Hashimoto Department of Orthopaedics, Osaka University Graduate School of Medicine
[ Summary ] Patients with rheumatoid arthritis (RA) have a greater risk of osteoporosis and fractures than the general population. One of the most characteristic features seen in fractures occurring in patients with RA is a high incidence of fractures other than vertebral or hip, including those in the pelvis and lower extremities. Another characteristic is the high incidence of insufficiency fractures which are difficult to properly diagnose. It is essential to prevent further functional loss due to fractures in cases where they have occurred in RA patients and also to prevent future fractures. In order to do that, we must become skilled at diagnosing insufficiency fractures in patients with RA and gain a deep understanding of the importance of preventing secondary osteoporosis soon after diagnosing RA.
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