Medikamentöse Therapie der Osteoporose

Zusammenfassung

Die wichtigsten Indikationen für eine medikamentöse Therapie der Osteoporose sind das Vorliegen eines starken klinischen Risikofaktors in Kombination mit einer erniedrigten DXA-Knochendichtemessung. Medikamente der ersten Wahl sind die antiresorptiv wirkenden Bisphosphonate Alendronat und Risedronat sowie das Raloxifen. Eine Östrogentherapie wird heute nur noch als Reservetherapie empfohlen. Mit dem täglich subkutan verabreichten Teriparatid steht seit kurzem ein neues anabol wirkendes Medikament zur Verfügung.

Summary

Pharmacological treatment of osteoporosis is recommended in the presence of both a strong clinical risk factor and a low DXA bone mineral density. Among the antiresroptive agents the two bisphosphonates alendro-nate and risedronate and raloxifene are first choice. Estrogen treatment is nowadays only recommended as secondline treatment. Teriparatide, given by once-daily injection, stimulates bone formation and has been recently approved for the treatment of postmenopausal osteoporosis.

Schlüsselwörter

Osteoporose - Östrogene - Bisphosphonate - Raloxifen - Teriparatid

Keywords

Osteoporosis - estrogen - bisphosphonates - raloxifene - teriparatide

• Literatur

• 1 Adami S., Viapiana O.. Ibandronate: New option in the treatment of osteoporosis. Drugs Today 2003; 39: 877-86.
• 2 Amin S., Lavalley MP., Simms RW.. et al The comparative efficacy of drug therapies used for the management of corticosteroid-induced osteoporosis: a meta-regression. J Bone Miner Res 2002; 17: 1512-26.
• 3 Cranney A., Wells G., Willian A.. et al Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 2002; 23: 508-16.
• 4 Cranney A., Tugwell P., Adachi J.. et al Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23: 517-23.
• 5 Cummings SR., Black DM., Thompson DE.. et al Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280: 2077-82.
• 6 Dargent-Molina P., Douchin MN., Cormier C.. et al Use of clinical risk factors in elderly women with low bone mineral density to identify women at higher risk of hip fracture: the EPIDOS prospective study. Osteoporos Int 2002; 13: 593-9.
• 7 Delmas PD., Ensrud KE., Adachi JD.. et al Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomi-zed clinical trial. J Clin Endocrinol Metab 2002; 87: 3609-17.
• 8 Ettinger B., Black DM., Mitlak BH.. et al Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene. JAMA 1999; 282: 637-45.
• 9 Kanis JA., Black D., Cooper C.. et al A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int 2002; 13: 527-36.
• 10 Neer RM., Arnaud CD., Zanchetta JR.. et al Effect of parathyroid hormone (1)34 on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434-41.
• 11 Neves-e-Castro M., Samsioe G., Dören M.. et al Results from WHI and HERS II – Implications for women and the prescriber of HRT. Maturitas 2002; 42: 255-8.
• 12 Pfeilschifter J.. Rationale und rationelle Osteoporoseprophylaxe und –therapie. Der Internist 2002; 43: 554-62.
• 13 Pfeilschifter J.. (Hrsg). Die DVO-Leitlinien zur Osteoporose. Osteologi. 2003; 12: 49-137.
• 14 Pfeilschifter J., Pientka L., Scheidt-Nave Ch.. Osteoporose in Deutschland 2003 – Eine Be-standsaufnahme. MMW Munch Med Wochenschr 2003; 145: 42-3.
• 15 Reginster JY., Deroisy R., Jupsin I.. Strontium ranelate: A new paradigm in the treatment of osteoporosis. Drugs Today 2003; 39: 89-101.
• 16 Roy DK., O’Neill TW., Finn JD.. et al Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 2003; 14: 19-26.
• 17 Sorensen OH., Crawford GM., Mulder H.. et al Long-term efficacy of risedronate: a 5-year placebo-controlled clinical experience. Bone 2003; 32: 120-6.
• 18 Van Staa TP., Leufkens HGM., Cooper C.. Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 2002; 13: 624-9.
• 19 Van Staa TP., Laan RF., Barton IP.. et al Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 2003; 48: 3224-9.