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Beeinflussung der Knochenheilung durch häufig verordnete Medikamente

Influence of frequently prescribed drugs on bone healing

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Zusammenfassung

Hintergrund

Die Knochenheilung nach Frakturen wird durch eine Vielzahl verschiedener Faktoren beeinflusst. Neben patientenseitigen Parametern, wie Alter, Geschlecht oder Nebenerkrankungen, haben auch die eingenommenen Medikamente einen wesentlichen Einfluss auf die Knochenheilung.

Ziel der Arbeit

Ziel der vorliegenden Arbeit ist es, einen Überblick über die Auswirkungen von häufig verwendeten Medikamenten, außer spezifischen Osteoporosemedikamenten und Hormonpräparaten, auf die Knochenheilung zu geben.

Material und Methode

Der Überblick wurde auf der Basis einer MEDLINE-Recherche zu den jeweiligen Stichworten durchgeführt.

Ergebnisse

Es wurden verschiedene häufig verwendete Medikamente identifiziert, darunter Kortikosteroide, Antihypertensiva, Diuretika, Antidepressiva, Antiepileptika, Statine, Antibiotika, nichtsteroidale Antirheumatika, Antikoagulanzien und andere. Mit Ausnahme der Antihypertensiva, Thiaziddiuretika und Statine wurden in tierexperimentellen und präklinischen Studien negative Effekte auf die Knochenheilung nachgewiesen. Für die 3 genannten Substanzklassen wurden osteoprotektive Wirkungen publiziert. Klinische Daten beim Menschen sind nur vereinzelt zu finden.

Schlussfolgerung

Die in präklinischen Studien gewonnenen Daten zur Beeinflussung der Frakturheilung belegen Effekte der im Folgenden betrachteten Medikamente. Dabei sind die Wirkungen beim Menschen teilweise noch nicht durch Studien gesichert. Vor dem Hintergrund der im vorliegenden Beitrag zusammengefassten Ergebnisse sollte in kritischen Fällen die weitere Einnahme der Medikamente diskutiert werden.

Abstract

Background

Bone healing after fractures is influenced by many different factors. Besides patient-related factors, such as age, gender and other comorbidities, other drugs taken also have a relevant impact on bone healing.

Objective

The aim of the study was to give an overview of the effects of frequently used drugs on fracture healing, with the exception of specific osteoporosis drugs and hormones.

Material and methods

This overview is based on a medline search with the search string of each pharmacological agent.

Results

Frequently used pharmacological substances were identified, for example corticosteroids, antihypertensive drugs, diuretics, antidepressive drugs, antiepileptics, statins, antibiotics, nonsteroidal anti-inflammatory drugs, anticoagulants and others. Except for antihypertensive drugs, thiazide diuretics and statins, which have osteoprotective effects and stimulate bone healing, all other drugs have negative effects on fracture healing in preclinical and animal studies. Clinical data are scarce.

Conclusion

Data for the effects of the abovementioned pharmacological substances could be found mostly in preclinical studies. The effects of these agents on bone healing in humans has currently not been studied or published. Therefore, the use of these drugs should be discussed carefully in cases with a compromised fracture healing.

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Authors and Affiliations

  1. Pius-Hospital, Universitätsklinik für Orthopädie und Unfallchirurgie, Carl von Ossietzky Universität, Georgstr. 12, 26121, Oldenburg, Deutschland

    Uwe Maus, Gerrit Steffen Maier & Djordje Lazovic

  2. Orthopädische Gemeinschaftspraxis, Liecker Str. 23, 52525, Heinsberg, Deutschland

    Christopher Niedhart

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  1. Uwe Maus
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  2. Gerrit Steffen Maier
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  3. Djordje Lazovic
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  4. Christopher Niedhart
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Correspondence to Uwe Maus.

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Interessenkonflikt

U. Maus, G.S. Maier, D. Lazovic und C. Niedhart geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Maus, U., Maier, G.S., Lazovic, D. et al. Beeinflussung der Knochenheilung durch häufig verordnete Medikamente. Unfallchirurg 122, 500–505 (2019). https://doi.org/10.1007/s00113-019-0670-4

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