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Arthritis und Rheuma 2015; 35(04): 217-222
DOI: 10.1055/s-0037-1618373
Osteologie
Schattauer GmbH

Unerwünschte Spätfolgen einer Bisphosphonattherapie

Unwanted side effects of a longterm bisphosphonate therapy
V. Koeppen
1   Interdiziplinäres Osteoporosezentrum, Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München
,
R. Skripitz
2   Orthopädische Klinik, Universitätsmedizin Rostock, Rostock
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
27. Dezember 2017 (online)

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Zusammenfassung

Bei den Langzeitfolgen von Bisphosphonaten führen neben vermeintlicher Kanzerogenität und bisphosphonatassoziierten Kiefernekrosen insbesondere auch atypische Femurschaftfrakturen zu Verunsicherung. Kiefernekrosen treten fast ausschließlich unter onkologisch dosierter i. v.-Bisphosphonattherapie auf und können durch eine vorausschauende Zahnsanierung minimiert werden. Unter oraler Applikation und gewöhnlicher Dosis bei Osteoporose liegt die Inzidenz bei < 0,1 %. Eine Bisphosphonattherapie geht mit einem erhöhten Risiko für atypische Femurschaftfrakturen einher. Auch wenn die Gesamtinzidenz mit elf Frakturen pro 10 000 Personenjahren gering ist, steigt das Risiko unter fort-währender Medikation an. Die Chance hierauf ist nach vier bis fünf Jahren Bisphosphonattherapie über 100-Mal höher als ohne Therapie. Nach Absetzen der Bisphosphonate verringerte sich das Risiko rasch um 70 % pro Jahr. So denn das Nutzen-Risiko-Verhältnis zu Beginn der Therapie bei geeigneter Indikation noch sehr günstig ist, könnte dies bei prolongierter Therapie invertiert werden. Dementsprechend sollten sowohl die Indikation und Therapiedauer sowie mögliche Prodrome der Nebenwirkungen regelmäßig vom Arzt kontrolliert werden.

Summary

Among the side effects of long-term bisphosphonate medication there is osteonecrosis of the jaw and atypical femoral fractures. Osteonecrosis of the jaw essentially happens under oncological dosed, i. v. bisphophonate therapy and can be minimized by foresightful dental caretaking. Under oral application and common dose for osteoporosis the incidence lies by less than 0.1 %. Bisphosphonates are associated with an increased risk for atypical femoral fractures. Even though the total incidence is low with only 11 atypical fractures per 10 000 person-years, the risk increases dramatically with ongoing therapy. The chance of suffering an atypical femoral fracture after four to five years of therapy is over a hundred times higher than without bis -phosphonate medication. After discontinuation the risk decreases rapidly by 70 % per year. Under prolonged bisphosphonate therapy there is no certain further risk reduction of frailty fracture, but the risk of an atypical femoral fracture increases drastically. While the benefit of bisphophonates at the beginning of a well indicated therapy outweigh, their effect might be inverted with prolonged therapy. Indication and treatment duration, as well as possible prodroms of side effects must therefore be regularly checked on by the treating physician.

Schlüsselwörter

Bisphosphonate - atypische Femurschaftfraktur - Bisphosphonat-assoziierte Kiefernekrose

Keywords

Bisphophonates - atypical femoral fracture - bisphosphonate-related osteonecrosis of the jaw
 

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