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. 2022 Mar;81(2):125-133.
doi: 10.1007/s00393-021-01128-7. Epub 2022 Jan 10.

[Glucocorticoid-induced osteoporosis-Focus treatment (part 2)]

[Article in German]
Peter Oelzner  1 , T Eidner  2 , A Pfeil  2
Affiliations

[Glucocorticoid-induced osteoporosis-Focus treatment (part 2)]

[Article in German]
Peter Oelzner et al. Z Rheumatol. 2022 Mar.

Abstract
in English, German

The following substances are approved for the treatment of glucocorticoid-induced osteoporosis: the oral bisphosphonates alendronate and risedronate, the intravenous bisphosphonate zoledronate, the RANKL antibody denosumab as antiresorptive substances and teriparatide as osteoanabolic substance. In comparison to placebo a reduction of vertebral fractures is proven for all mentioned substances. Thereby, teriparatide is more effective than alendronate and risedronate with respect to the reduction of vertebral fractures. The severity of osteoporosis, especially the presence of osteoporotic fractures, the approach of treatment (preventive or curative) and contraindications are factors that are important for the differentiated application of the mentioned substances. Furthermore, it must be noted that the effect of osteoanabolic treatment must be stabilized by a subsequent antiresorptive treatment and that after termination of antiresorptive treatment with denosumab a temporary bisphosphonate treatment is required to prevent a rebound phenomenon.

Für die Behandlung der Glukokortikoid-induzierten Osteoporose sind folgende Substanzen zugelassen: die oralen Bisphosphonate Alendronat und Risedronat, das intravenöse Bisphosphonat Zoledronat, der RANKL-Antikörper Denosumab als antiresorptiv wirksame Substanzen und Teriparatid als osteoanabole Substanz. Im Vergleich zu Placebo ist für alle genannten Substanzen eine Reduktion vertebraler Frakturen belegt. Dabei ist Teriparatid im Hinblick auf die Reduktion vertebraler Frakturen wirksamer als Alendronat und Risedronat. Schweregrad der Osteoporose, insbesondere das Vorliegen osteoporotischer Frakturen, der Ansatz der Therapie (präventiv oder kurativ) und das Vorliegen von Kontraindikationen sind Faktoren, die für den differenzierten Einsatz der genannten Substanzen von Bedeutung sind. Ferner muss beachtet werden, dass der Effekt einer osteoanabolen Therapie mit einer sich anschließenden antiresorptiven Therapie stabilisiert werden muss und dass nach Beendigung einer antiresorptiven Therapie mit Denosumab eine zeitlich befristete Bisphosphonattherapie erforderlich ist, um ein Reboundphänomen zu verhindern.

Keywords: Antiresorptive treatment; Bisphosphonates; Contraindications; Osteoanabolic treatment; Vertebral fracture.

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References

Literatur

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