PDF herunterladen
Dtsch Med Wochenschr 2019; 144(16): 1111-1119
DOI: 10.1055/a-0841-8336
Dossier
© Georg Thieme Verlag KG Stuttgart · New York

Personalisierte Osteoporose-Therapie

Personalized Therapy In Osteoporosis
Karoline Schulz
,
Hannes Kalscheuer
,
Hendrik Lehnert
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
15. August 2019 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

In Germany, over six million people suffer from osteoporosis. Nearly half of the women over 70 years and nearly 20 % of men at the same age are affected. The clinical and socioeconomical relevance of the disease lies in osteoporotic fractures leading to extensive bone-associated morbidity, increased mortality and health care costs. Fracture risk algorithms and guidelines for the diagnosis and treatment of osteoporosis help to assess the individual fracture risk. By calculating the individual fracture risk, the indication for specific osteoporosis treatment can objectively be determined. A consequent specific osteoporosis therapy is required for patients with a high fracture risk and is essential to prevent osteoporotic fractures and their consequences. As first-line therapy a drug with a proven fracture-reducing effect should be taken. However, for successful osteoporosis therapy, many individual factors have to be considered. A personalized treatment approach should be established according to the severity of the disease, the patient’s sex and comorbidities as well as the possible additive and side effects of the drug.

Rund 6 Millionen Menschen sind in Deutschland an Osteoporose erkrankt, überwiegend Frauen nach den Wechseljahren. Aber auch andere Patientengruppen sind betroffen, z. B. bei Langzeit-Einnahme von Glukokortikoiden. Es gibt klare Empfehlungen zur Behandlung der Osteoporose. Der Praktiker sollte diese kennen und darüber hinaus wissen, welche individuellen Faktoren (v. a. Komorbiditäten) neben der Ursache zu berücksichtigen sind.

Schlüsselwörter

Osteoporose - personalisierte Therapie - Bisphosphonate - Denosumab - Teriparatid

Key words

osteoporosis - personalized therapy - bisphosphonates - denosumab - teriparatide
 

  • Literatur

  • 1 Scheidt-Nave C, Banzer D, Abendroth K. Schlussbericht Multizentrische Studie zu Verteilung, Determination und prädiktivem Wert der Knochendichte in der deutschen Bevölkerung Förderprojekt des Bundesministeriums für Forschung und Technologie Förderkennzeichen 01KM 9304/0. 1997: 1-45
    PubMedGoogle Scholar
  • 2 Hadji P, Klein S, Gothe H. et al. The epidemiology of osteoporosis--Bone Evaluation Study (BEST): an analysis of routine health insurance data. Dtsch Arztebl Int 2013; 110: 52-57 . doi:10.3238/arztebl.2013.0052
    CrossrefPubMedGoogle Scholar
  • 3 Dachverband Osteologie. Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern (2017). Im Internet: www.dv-osteologie.org/uploads/Leitlinie%202017/Finale%20Version%20Leitlinie%20Osteoporose%202017_end.pdf ; Stand 25.01.2019
    PubMedGoogle Scholar
  • 4 Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet 2019; 393: 364-376 . doi:10.1016/S0140-6736(18)32112-3
    CrossrefPubMedGoogle Scholar
  • 5 Gennari L, Bilezikian JP. New and developing pharmacotherapy for osteoporosis in men. Expert Opin Pharmacother 2018; 19: 253-264 . doi:10.1080/14656566.2018.1428559
    CrossrefPubMedGoogle Scholar
  • 6 Lyles KW, Colón-Emeric CS, Magaziner JS. et al. HORIZON Recurrent Fracture Trial. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007; 357: 1799-1809 . doi:10.1056/NEJMoa074941
    CrossrefPubMedGoogle Scholar
  • 7 Kanis JA, Cooper C, Rizzoli R. et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019; 30: 3-44 . doi:10.1007/s00198-018-4704-5
    CrossrefPubMedGoogle Scholar
  • 8 Silverman SL, Schousboe JT, Gold DT. Oral bisphosphonate compliance and persistence: a matter of choice?. Osteoporos Int 2011; 22: 21-26 . doi:10.1007/s00198-010-1274-6
    CrossrefPubMedGoogle Scholar
  • 9 Rizzoli R, Reginster JY, Boonen S. et al. Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis. Calcif Tissue Int 2011; 89: 91-104 . doi:10.1007/s00223-011-9499-8
    CrossrefPubMedGoogle Scholar
  • 10 Guañabens N, Moro-Álvarez MJ, Casado E. SEIOMM Working Group. et al. The next step after anti-osteoporotic drug discontinuation: an up-to-date review of sequential treatment. Endocrine 2019; DOI: 10.1007/s12020-019-01919-8.
    CrossrefPubMedGoogle Scholar
  • 11 Eastell R, Rosen CJ, Black DM. et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104: 1595-1622 . doi:10.1210/jc.2019-00221
    CrossrefPubMedGoogle Scholar
  • 12 Black DM, Schwartz AV, Ensrud KE. FLEX Research Group. et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 2006; 296: 2927-2938 . doi:10.1001/jama.296.24.2927
    CrossrefPubMedGoogle Scholar
  • 13 Black DM, Reid IR, Cauley JA. et al. The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 2015; 30: 934-944 . doi:10.1002/jbmr.2442
    CrossrefPubMedGoogle Scholar
  • 14 Bone HG, Wagman RB, Brandi ML. et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomized FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 2017; 5: 513-523 . doi:10.1016/S2213-8587(17)30138-9
    CrossrefPubMedGoogle Scholar
  • 15 Dede AD, Callan M. Treatment of osteoporosis: whom, how and for how long?. Br J Hosp Med (Lond) 2018; 9: 259-264 . doi:10.12968/hmed.2018.79.5.259
    PubMedGoogle Scholar
  • 16 Ettinger B, Black DM, Mitlak BH. et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999; 282: 637-645
    CrossrefPubMedGoogle Scholar
  • 17 Cauley JA, Robbins J, Chen Z. Women’s Health Initiative Investigators. et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial. JAMA 2003; 290: 1729-1738
    CrossrefPubMedGoogle Scholar
  • 18 Compston J, Cooper A, Cooper C. National Osteoporosis Guideline Group (NOGG). et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 2017; 12: 43 . doi:10.1007/s11657-017-0324-5
    CrossrefPubMedGoogle Scholar
  • 19 Dede AD, Makras P, Anastasilakis AD. Investigational anabolic agents for the treatment of osteoporosis: an update on recent developments. Expert Opin Investig Drugs 2017; 26: 1137-1144 . doi:10.1080/13543784.2017.1371136
    CrossrefPubMedGoogle Scholar
  • 20 Duckworth AD, McQueen MM, Tuck CE. et al. Effect of Alendronic Acid on Fracture Healing: A Multicenter Randomized Placebo-Controlled Trial. J Bone Miner Res 2019; DOI: 10.1002/jbmr.3679.
    CrossrefPubMedGoogle Scholar
  • 21 Miller PD. Osteoporosis in patients with chronic kidney disease: Management. Im Internet: https://www.uptodate.com/contents/osteoporosis-in-patients-with-chronic-kidney-disease-management ; Stand 01.04.2019
    PubMedGoogle Scholar