Wirkungen der Analgetika auf den Knochenstoffwechsel

Zusammenfassung

Tierexperimentell können NSAR die Knochenbruchheilung hemmen. In einer Fallkontrollstudie konnte aber eine frakturfördernde Wirkung nicht ausreichend belegt werden. Werden Protonenpumpenhemmer eingesetzt, so besteht die Gefahr einer Erhöhung der Hüftfrakturwahrscheinlichkeit. Bei Opioiden ist eine Hemmung der Osteoblastenfunktion dokumentiert. Damit in Einklang steht eine Erhöhung der Frakturwahrscheinlichkeit durch Opioide in Fallkontrollstudien; die Wirkung ist aber eher durch Schwindel und eine vermehrte Sturzneigung durch die Opioide bedingt.

Summary

Experimental data show impaired fracture healing under the influence of NSAID therapy. Clinical data, however do not support an increased incidence of osteoporotic fractures with the use of NSAIDs. When proton pump inhibitors are used as a comedication with NSAID therapy the incidence of hip fractures is significantly increased. Opioids inhibit osteoblast function. The fracture risk has been shown to be increased with the use of morphines and opiates in one case control study. The increased incidence of osteoporotic fractures with the use of morphines is rather caused by nausea and an increased risk of falls than by their effect on bone metabolism.

Schlüsselwörter

NSAR - Osteoporose - Fraktur - Opiat

Keywords

NSAID - osteoporosis - fracture risk - opioid

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