Osteologie 2019; 28(02): 116-121
DOI: 10.1055/a-0832-2837
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Langzeitsicherheit von Bisphosphonaten

Long-term safety of bisphosphonates
Rudolf Wolfgang Gasser
Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Österreich
› Author Affiliations
Further Information

Publication History

20 June 2018

11 January 2019

Publication Date:
24 May 2019 (online)

Zusammenfassung

Bisphosphonate sind derzeit die am häufigsten verwendeten Medikamente bei metabolischen Knochenerkrankungen, insbesondere bei Osteoporose, die Wirksamkeit ist durch Studien gut belegt. Bisphosphonate führen bei Osteoporose zu einer Reduktion des Knochenmineralverlusts und zu einer Senkung des Frakturrisikos. Neben den bekannten Kurzzeit-Nebenwirkungen wurden bei einer Langzeittherapie mit Bisphosphonaten potentielle Sicherheitsrisiken und Nebenwirkungen festgestellt. Zu diesen sehr seltenen Langzeitnebenwirkungen zählen: Kieferosteonekrose, atypische Femurfraktur, Muskel- und Skelettschmerzen, Vorhofflimmern und Ösophaguskarzinom. Dabei ergab sich teilweise keine eindeutige Kausalität aber eine Evidenz für ein vermehrtes, wenn auch sehr seltenes Auftreten. Eine Awareness gegenüber diesen Nebenwirkungen ist jedoch erforderlich. Bei leitliniengerechter Indikationsstellung und adäquater Prophylaxe, z. B. im Falle einer möglichen Kiefernekrose, überwiegen bei den meisten Patienten die Vorteile einer Bisphosphonattherapie gegenüber den möglichen Risiken. Unter Berücksichtigung des individuellen Frakturrisikos ist nach 3–5 Jahren Behandlung eine Therapiepause (drug holiday ) möglich, um die Gefahr von Nebenwirkungen zu reduzieren.

Abstract

Bisphosphonates are currently the most commonly used drugs in metabolic bone disease, especially in osteoporosis, and efficacy is well documented in studies. The aim of this review, based on existing studies, is to summarize the positive and negative aspects of a long-term therapy with bisphosphonates. Bisphosphonates in osteoporosis lead to a reduction in bone mineral loss and a reduction in fracture risk at the spine, hip and other nonvertebral sites. In addition to the known short-term side effects (irritation oft the esophagus, acute-phase reactions or renal toxicity), potential safety risks and adverse events have been identified in long-term bisphosphonate therapy. These very rare long-term side effects include: osteonecrosis of the jaw, atypical femur fracture, muscle and skeletal pain, atrial fibrillation and esophageal cancer. In some cases, there was no clear causality but there is evidence for an increased, albeit very rare, occurrence. However, an awareness of these adverse events is required. For guideline-appropriate indication and adequate prophylaxis, e. g. in the case of possible necrosis of the jaw, in most patients the benefits of bisphosphonate therapy outweigh the potential risks. Since bisphosphonates have a longer residence time in the bone, taking into account the individual fracture risk after 3–5 years of treatment, a therapy break of 2–3 years (drug holiday) is possible to reduce the long-term risks.

 
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