Positive und negative (Neben)Effekte bei Osteoporose-Sequenztherapie

Zusammenfassung

Indikationen und Abläufe rund um pharmakologischen Optionen für die Osteoporosetherapie wurden in den vergangenen Jahren neu beleuchtet. Dazu zählen neben den bekannten therapeutischen Effekten auf Knochenstoffwechsel, -struktur und Frakturrisiko auch teils weniger bekannte positive (Neben-)Effekte und einige, wenn auch seltene, gravierende Nebenwirkungen dieser Medikamente. Als positive (Neben-)Effekte wurden bei Bisphosphonaten u. a. die Reduktion von kardiovaskulären Ereignissen, die verminderte Inzidenz von Karzinomen und eine insgesamt verminderte Mortalität beschrieben, es gab bei suffizienter Basistherapie aber u. a. auch reduzierte Raten für COVID-Infektionen und -Hospitalisierungen. Antiresorptiva können seltene, aber erhebliche Nebenwirkungen bei Betroffenen bewirken, u. a. sind es atypische Schenkelhalsbrüche (AFF, „atypical femoral fractures“), die in 0.02% der Fälle bei langdauernder Behandlung auftreten. Vielbeachtet sind Kieferosteonekrosen (MRONJ, „Medication-Related OsteoNecrosis of the Jaw“), die vermehrt bei hohen und häufigen Dosen, etwa bei onkologischer Indikation auftreten und bei Osteoporose-Indikation in 0.001%-0.01% der Betroffenen mit Osteoporosetherapie-Schemata gefunden werden. Zu Augen-assoziierten Symptomen (BROSE, „Bisphosphonat-Related Ocular Side Effects”) sind bisher etwa zwei Dutzend Fälle weltweit publiziert worden. In dieser Übersichtsarbeit werden wichtige Daten und Mechanismen zu Nebeneffekten der Osteoporose-Therapeutika auch bei speziellen Personengruppen zusammengefasst und neue Entwicklungen im Rahmen einer Osteoporose-Sequenztherapie sowie Vorsorgemaßnahmen beschrieben.

Abstract

Indications and procedures around pharmacological options for osteoporosis therapeutics have been reviewed during the past years. Besides well-known therapeutic effects on bone metabolism, structure and fracture risk, several positive effects outside the bone have been recorded; however, also a number of rare, but serious side effects caused by bone-active medication. Positive effects were recorded for beneficial impacts on cardiovascular events, reduced incidences for carcinomas and reduced mortality, but also reduced infection and hospitalisation rates for COVID with sufficient baseline therapies. However, antiresorptive therapies may have rare, but severe side effects - e. g., atypical femoral fractures (AFF), occurring in 0.02% of cases, mostly during long-standing treatments. Widely noticed side effects are “Medication-Related OsteoNecroses of the Jaw“ bone (MRONJ), mainly related to high and long-standing doses of antiresorptive medication applied for oncological reasons, while occurring in 0.001%-0.01% of osteoporosis patients. Eye-related symptoms (BROSE, „Bisphosphonat-Related Ocular Side Effects”), have been described in some twenty cases worldwide. In this review, descriptions and mechanisms about side effects of osteoporosis medication are summarized also for special patient groups. New developments including sequential therapy as well as prophylactic measures are described.

Schlüsselwörter

Osteoporose - Therapie - Risikofaktoren - Nebeneffekte

Keywords

Osteoporosis - Therapy - Side effects - Risk factors

Publication History

Received: 02 January 2024

Accepted: 24 January 2024

Article published online:
16 May 2024

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