Bisphosphonate in der Therapie der Osteoporose

Zusammenfassung

Die Bisphosphonate sind potente Hemmer des Knochenabbaus. Vertreter dieser Substanzklasse sind heute als die Therapie der ersten Wahl der Osteoporose anzusehen. Mit Etidronat, Alendronat und Risedronat stehen in Deutschland drei zugelassene, oral applizierbare Substanzen zur Verfügung. Alle drei Substanzen wurden mit Studien, deren Qualitätsstandards den Anforderungen der jeweiligen Zeit der Studiendurchführung entsprechen, untersucht. Für Alendronat und Risedronat sind Effekte auf die periphere Frakturwahrscheinlichkeit dokumentiert, wobei insbesondere für Alendronat die Datenlage zur Reduktion des Risikos für Schenkelhalsfrakturen so dicht ist, dass die Zulassungsbehörde die Indikation der Verminderung des Risikos von hüftgelenknahen Femurfrakturen aussprach. Die Therapie mit den Bisphosphonaten darf als sehr sicher und nebenwirkungsarm angesehen werden. Hervorzuheben ist aber, dass das für die Alendronat-Behandlung beschriebene Risiko von peptischen Schleimhautläsionen im distalen Ösophagus dahingehend besonders zu beachten ist, dass die rigiden, vom Hersteller selbst vorgegebenen Einnahmevorschriften unbedingt eingehalten werden müssen, da man ansonsten in der Tat im klinischen Alltag diese Nebenwirkungen auch beobachten wird. Die Wahl des Präparates hängt vom Erkenntnisstand zur Wirkung der jeweiligen Substanz auf die Osteoporose, der Situation des Patienten einschließlich seiner Fähigkeit, diffizile Einnahmemodalitäten dauerhaft zu beachten, den objektiven Daten und subjektiven Beobachtungen zur Verträglichkeit und nicht zuletzt auch vom Preis des Medikaments ab.

Bisphosphonates in the Treatment of Osteoporosis.

Bisphosphonates are potential inhibitors of osteoclasia, i. e. the absorption and destruction of bone tissue and are today’s treatment of choice in osteoporosis. Three approved orally administered substances are available in Germany in this regard, namely, ethidronate, alendronate and risedronate. These three substances have been tested by means of studies in accordance with present quality standards. Effects amounting to a reduced probability of peripheral fractures have been confirmed and documented for alendronate and risedronate. In particular, the data available for alendronate in respect of reducing the risk of femoral neck fractures are so convincing that the health authorities have passed this substance for reducing fractures close to the femur. Bisphosphonate therapy can be regarded as very safe and associated with only few side effects. However, it must be pointed out that special attention should be paid to the risk associated with alendronate in respect of peptic mucosal lesions in the distal oesophagus and hence the rigid instructions for use issued by the manufacturers must be strictly followed, since otherwise these side effects are actually noticeable in everyday clinical practice. The choice of the preparation depends on the state of knowledge of the effects of the substance on osteoporosis, as well as on the patient status and his ability to pay close and continued attention to rigid adherence to the minutely prescribed instructions for intake and on the objective data and subjective observations regarding tolerance and last but by no means least on the price of the medicament.

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