Bisphosphonattherapie bei renaler Osteopathie

Zusammenfassung

Bisphosphonate sind in der Therapie der Osteoporose und maligner Knochenerkrankungen inzwischen Standard. Da Bisphosphonate ausschließlich renal ausgeschieden werden, ist eine schwere Niereninsuffizienz eine Kontraindikation für den Einsatz der meisten Bisphosphonate. Bei Dialysepatienten liegen jedoch in der Regel ausgeprägte Veränderungen des Knochenstoffwechsels vor, die zumindest teilweise den Einsatz von Bisphosphonaten sinnvoll erscheinen lassen. Tierexperimentelle Studien belegen, dass durch die Gabe eines Bisphosphonats die Veränderungen eines hyperparathyreoiden Knochens verhindert werden konnten. Daten zu Clodronat, Pamidronat und Ibandronat zeigen, dass diese Bisphosphonate gut dialysabel sind und ein Einsatz bei Dialysepatienten von dieser Seite her möglich ist. In ersten Pilotstudien an Dialysepatienten konnte dieser positive Effekt aus den tierexperimentellen Studien bestätigt werden. Es fehlen jedoch derzeit größere placebokontrollierte Studien, die den Einsatz von Bisphosphonaten in der Therapie der renalen Osteopathie soweit belegen, dass dieser als allgemeine Therapieempfehlung ausgesprochen werden kann.

Summary

Bisphosphonates are standard treatment in osteoporosis and malignant bone disease. Because they are eliminated exclusively by the kidneys, the most bisphosphonates are not indicated in severe renal insufficiency. Dialysis patients very often suffer from bone disease, so in some of them a treatment with bisphosphonates may be suggestive. Animal experimental trials demonstrate, that bisphosphonates are able to block the effect of the hyperparathyreoidism on the bone. Clodronate, Pamidronate and Ibandronate are investigated to be dialyzable, so their use also in dialysis patients might be possible. Some pilot studies could confirm the positive effects observed in the animal experimental trials on hyperparathyreoid bone disease in dialysis patients. But because of the lack of randomized placebo controlled trials in this indication, their use in dialysis patients could not be generally recommended at the time.

Schlüsselwörter

Bisphosphonate - Dialyse - renale Osteopathie - high-turnover-Osteopathie - Hyperparathyreoidismus

Keywords

Bisphosphonate - dialysis - renal osteodystrophy - high turn over osteopathy - hyperparathyreoidism

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