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Osteologie 2023; 32(02): 115-122
DOI: 10.1055/a-2034-6086
Leitlinie

Recommendations for the Pharmacological Treatment of Osteoporosis – Update 2023 of the German Osteoporosis Guideline

Empfehlungen zur spezifischen medikamentösen Therapie der Osteoporose – Update 2023 der DVO-Leitlinie
Ralf Schmidmaier
1   Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
,
Peyman Hadji
2   Frankfurt Center for Bone Health and Endocrinology and Philipps-Universität Marburg, Marburg, Germany
,
Peter Kern
3   Department for Internal Medicine IV (Immunology, Rheumatology and Osteology), University Medicine Marburg – Campus Fulda, University of Marburg, Marburg, Germany
,
Michael Drey
4   Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, Munich, Germany
,
Franz Jakob
5   Bernhard-Heine-Centrum für Bewegungsforschung, Julius-Maximilians-Universität Würzburg, Wurzburg, Germany
,
Friederike Thomasius
6   Frankfurt Center for Bone Health and Endocrinology, Frankfurt, Germany
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Abstract

Aim The German osteoporosis guideline was updated on the basis of a systematic literature review and through a structured consensus process by an interdisciplinary, international (Germany, Austria, Switzerland) expert group representing the 20 member societies of the Joint Osteological Association (DVO) and patient advocacy organizations (BfO). This manuscript summarizes the changes in the German osteoporosis guideline with regard to pharmacological interventions and offers pragmatic pathways for implementation.

Method Systematic literature search and structured consensus building according to AWMF regulations.

Results The sclerostin antibody romosozumab was adopted into the guideline. In addition, the effectiveness of teriparatide was re-evaluated. For both bone anabolic agents evidence from randomized trials underlined a superiority over oral bisphosphonates with regard to fracture risk reduction. Between the antiresorptive treatments, differences regarding superiority/inferiority could only be shown with respect to surrogate parameters, not with regard to fractures. Data about the duration of treatment of all available drugs is limited. All non-bisphosphonate treatments require follow-up treatment.

Conclusion An individualized treatment concept should be developed in a shared decision process, including a bone anabolic-first strategy in high-risk patients. Recommendations on treatment duration, drug holidays and sequential strategies should be considered.

Zusammenfassung

Ziel Auf Basis eines systematischen Literaturreviews und durch strukturierte Konsensfindung einer interdisziplinären, internationalen (Deutschland, Österreich, Schweiz) Expertengruppe, welche die 20 Mitgliedgesellschaften des Dachverbandes Osteologie (DVO) und die Patientenvertretung Bundesselbsthilfeverband für Osteoporose e.V. (BfO) repräsentiert, wurde die deutschsprachige S3-Osteoporoseleitlinie aktualisiert. In diesem Artikel werden die Neuerungen des Kapitels zur medikamentösen Therapie vorgestellt und Möglichkeiten zum Transfer in die tägliche Praxis diskutiert.

Methode Systematische Literaturrecherche und strukturierte Konsensfindung gemäß AWMF-Regelwerk.

Ergebnisse Neu aufgenommen wurde in die Leitlinie der Sklerostin Antikörper Romosozumab. Zudem erfolgte eine Neubewertung der Effektivität von Teriparatid. Für beide Osteoanabolika liegt Evidenz aus randomisierten, direkten Vergleichsstudien vor, die eine Überlegenheit gegenüber oralen Bisphosphonaten bezüglich Frakturrisikoreduktion zeigen. Innerhalb der Antiresorptiva konnten nur Unterschiede der Überlegenheit/Unterlegenheit bezüglich Surrogatparametern, nicht bezüglich Frakturen gezeigt werden. Die Daten zur Therapiedauer aller verfügbarer Medikamente sind limitiert. Nicht-Bisphosphonate erfordern eine Anschlusstherapie.

Schlussfolgerung Es sollte partizipativ ein individuelles Therapiekonzept entwickelt werden; bei Hochrisikopatienten mit einer Osteoanabol-First-Strategie. Empfehlungen zur Therapiedauer, Therapiepausen und notwendigen Sequenzen sind zu beachten.

Key words

Osteoporosis - guideline - drugs - treatment

Schlüsselwörter

Osteoporose - Leitlinie - Medikamente - Therapie


Publication History

Received: 29 December 2022

Accepted: 11 February 2023

Article published online:
25 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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