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DOI: 10.1055/s-2006-921432
© Georg Thieme Verlag Stuttgart · New York
Bisphosphonatwirkungen in der Endoprothetik
Effects of Bisphosphonates in ArthroplastyPublication History
Publication Date:
19 April 2006 (online)
![](https://www.thieme-connect.de/media/zfo/200602/lookinside/thumbnails/10.1055-s-2006-921432-1.jpg)
Zusammenfassung
Studienziel: In der vorliegenden Arbeit wird eine Übersicht über die allgemeinen Wirkungen und insbesondere über die Wirkungen von Bisphosphonaten auf verschiedene Probleme in der Endoprothetik gegeben. Methode: Zunächst werden die chemischen Eigenschaften und dann die biologischen Wirkungen dargestellt. Diese Effekte zeigen bereits bekannte Auswirkungen auf orthopädische Krankheitsbilder. Es wird zunehmend untersucht, welche Effekte durch Bisphosphonate in der Endoprothetik erzielt werden. Ergebnisse: Die Stoffgruppe der Bisphosphonate ist von dem in der Industrie verwendeten Pyrophosphat, welches zur Vermeidung von Verkalkungen eingesetzt wurde, abgeleitet worden. Die Bisphosphonate hemmen die Mineralisation und die Knochenresorption. Mehrere direkte und indirekte Mechanismen sind für diese Wirkungen verantwortlich. Der therapeutische Nutzen der Hemmung der Knochenresorption erstreckt sich auf verschiedene Erkrankungen mit vermehrtem Knochenabbau. Die Bisphosphonate führen hier zur Erhöhung der Knochendichte und zur Verbesserung der mechanischen Knochenqualität. Zum Indikationsspektrum zählen die Osteoporose, tumorbedingte Knochendestruktionen, die fibröse Dysplasie und M. Paget. In jüngerer Zeit wurde gezeigt, dass Metallimplantate schneller einwachsen und der im Laufe der Prothesenstandzeiten, durch unterschiedliche Ursachen hervorgerufene periprothetische Knochenverlust, reduziert werden kann. Schlussfolgerung: Nachdem die Bisphosphonate bereits lange bei Knochenstoffwechselerkrankungen eingesetzt wurden, könnten sie auch in der Gelenkendoprothetik von zunehmender Bedeutung werden.
Abstract
Aim: This study presents an overview of the general effects of bisphosphonates and in particular of their effects on different problems in joint arthroplasty. Method: First the chemical properties are described, then the biological effects. It is already known that bisphosphonates have effects on orthopaedic diseases and an increasing number of studies are investigating what effects can be achieved in joint arthroplasty with these substances. Results: The bisphosphonates group was derived from industrial pyrophosphate which is used to prevent calcification. Bisphosphonates inhibit bone mineralisation and resorption. Several direct and indirect mechanisms are responsible for these effects. The inhibition of bone resorption is used to benefit patients suffering from various diseases causing increased bone resorption. Treatment with bisphosphonates results in greater bone density and improved mechanical bone quality. Indications for this treatment include osteoporosis, tumour-associated osseodestructions, fibrous dysplasia and Paget's disease. Recent studies have shown that osseointegration of metal implants is accelerated and periprosthetic bone loss, which is caused by various different mechanisms during the lifetime of an implant, can be reduced. Conclusion: Bisphosphonates have been an established element in the treatment of bone metabolic disorders for many years. Their use in joint arthroplasty could become increasingly important.
Schlüsselwörter
Bisphosphonate - Endoprothese - Osteointegration - Osteolyse - kumulative Therapie
Key words
bisphosphonate - arthroplasty - osseointegration - osteolysis - cumulative therapy
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J. Brankamp
Klinik für Orthopädie, Universität Duisburg-Essen, Klinikum Essen Süd
Pattbergstr. 1-3
45239 Essen
Phone: 00 49/(0)2 01/40 89/21 60
Fax: 00 49/2 01/40 89/27 22
Email: j.brankamp@web.de