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Pharmakogene Osteoporose jenseits von Kortison

Protonenpumpenhemmer, Glitazone, Diuretika

Pharmacogenic osteoporosis beyond cortisone

Proton pump inhibitors, glitazones and diuretics

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Zusammenfassung

Hintergrund

Es gibt eine Reihe von Arzneimitteln, die eine Osteoporose verursachen oder ihre Entstehung zumindest begünstigen. So ist eine Wirkung von Hormonen und antihormonell wirksamen Arzneimitteln wie Glukokortikoiden und Aromatasehemmer auf die Entstehung von Osteoporose bekannt. Neben diesen haben auch Protonenpumpenhemmer, Glitazone und Diuretika Einfluss auf die Osteoporoseentstehung.

Material und Methoden

Es wurden die aktuellen Studien zu den Zusammenhängen zwischen Protonenpumpenhemmer, Glitazonen und Diuretika und der Entstehung von Osteoporose ausgewertet und zusammengestellt.

Ergebnis

Protonenpumpenhemmer und Glitazone steigern das Risiko für osteoporotische Frakturen. Der Gebrauch von Schleifendiuretika steigert das Frakturrisiko wahrscheinlich nur diskret, während Thiazide die Frakturwahrscheinlich in klinisch relevantem Umfang reduzieren können.

Schlussfolgerung

PPI sollten nicht unkritisch und nur so lange wie nötig verordnet werden. Ein Ausweichen auf die bezüglich der Reduktion der Säuresekretion schwächer wirksamen H2-Antagonisten sollte, wenn möglich, erwogen werden. Da die langfristige Einnahme von Thiaziden mit einer klinisch relevanten Reduktion des Frakturrisikos vergesellschaftet ist und sie preiswert und gut verträglich sind, ist im Rahmen differenzialdiagnostischer Erwägungen im entsprechenden klinischen Kontext eine Verordnung durchaus zu empfehlen. Einzig das kurzfristig erhöhte Sturzrisiko unmittelbar nach Beginn einer Diuretikatherapie ist zu beachten.

Abstract

Backround

There are many drugs which can cause osteoporosis or at least favor its initiation. The effect of hormones and drugs with antihormonal activity, such as glucocorticoids and aromatase inhibitors, on initiation of osteoporosis is well known. In addition, proton pump inhibitors, glitazones and diuretics also influence the formation of osteoporosis.

Material and methods

The results of currently available studies on the correlation between proton pump inhibitors, glitazones and diuretics on formation of osteoporosis were evaluated and summarized.

Results

Proton pump inhibitors and glitazones increase the risk for osteoporotic fractures. Loop diuretics may slightly increase fracture risk, whereas thiazides were shown to be osteoprotective by reducing fracture probability on a relevant scale.

Conclusion

Proton pump inhibitors should not be prescribed without serious consideration and then only as long as necessary. Alternatively, the administration of the less effective H2 antagonists should be considered when possible due to the reduction of acid secretion. Because the long-term intake of thiazides is associated with a clinically relevant reduction in the risk of fractures and they are economic and well-tolerated, prescription can be thoroughly recommended within the framework of differential diagnostic considerations in an appropriate clinical context. The briefly increased risk of falling immediately after starting diuretic therapy is the only point which needs to be considered.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P.H. Kann, P. Hadji und R.S. Bergmann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Zentrum für Innere Medizin – Bereich Endokrinologie & Diabetologie, Philipps-Universität Marburg/Universitätsklinikum Marburg UKGM, 35033, Marburg, Deutschland

    P.H. Kann M.A & R.S. Bergmann

  2. Klinik für Gynäkologie und Geburtshilfe – Bereich Gynäkologische Endokrinologie, Reproduktionsmedizin und Osteologie, -, -

    P. Hadji

  3. Klinisches Osteologisches Schwerpunktzentrum DVO, Philipps-Universität Marburg/Universitätsklinikum Marburg UKGM, Marburg, Deutschland

    P.H. Kann M.A, P. Hadji & R.S. Bergmann

  4. Endokrinologische Gemeinschaftspraxis, Frankfurt am Main, Deutschland

    P.H. Kann M.A

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  1. P.H. Kann M.A
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  2. P. Hadji
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  3. R.S. Bergmann
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Correspondence to P.H. Kann M.A.

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Kann, P., Hadji, P. & Bergmann, R. Pharmakogene Osteoporose jenseits von Kortison. Z. Rheumatol. 73, 323–328 (2014). https://doi.org/10.1007/s00393-013-1286-7

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