Stellenwert von Risedronat - Gastrointestinale Verträglichkeit von Bisphosphonaten

Zusammenfassung

Bisphosphonate sind wirksam in der Behandlung der postmenopausalen und glukokortikoidinduzierten Osteoporose. Einige dieser Wirkstoffe, wie zum Beispiel Pamidronat und Alendronat, werden jedoch mit Schädigungen des oberen Gastrointestinaltrakts in Verbindung gebracht: Die Folgen sind Ösophagitis, Ösophagusstrikturen, aber auch Erosionen und Ulzera im Magen. Obwohl die Ursachen dieser Veränderungen nicht gänzlich geklärt sind, spricht die anatomische Verteilung der Schäden in Magen und Speiseröhre dafür, dass es sich hierbei um einen lokalen toxischen Effekt handelt. Risedronat, ein Bisphosphonat der dritten Generation, scheint weniger Schäden am oberen Gastrointestinaltrakt zu verursachen - auch bei Patienten mit erhöhtem Risiko.

Summary

Bisphosphonates are effective for treatment and prevention of postmenopausal and glucocorticoid induced osteoporosis. Some bisphosphonates such as pamidronate and alendronate have been associated with upper gastrointestinal adverse effects: esophagitis, esophageal strictures as well as gastric erosions and ulcers. Although the clinical significance of these is still uncertain, the anatomic distribution of both the gastric ulcer and esophageal damage is consistent with a topical irritant effect. Risedronate, a third generation bisphosphonate, is apparently not associated with an increased frequency of adverse GI-tract effects among patients with a high risk for these events.

Key Words

bisphosphonates - osteoporosis - upper gastrointestinal adverse effects - gastric ulcers

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