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Einsatz der Bisphosphonate in der Orthopädie und Unfallchirurgie

Use of bisphosphonates in orthopedic surgery

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Zusammenfassung

In den letzten 3 Jahrzehnten wird die Substanzgruppe der Bisphosphonate (BP) bei Osteopathien, die durch eine gesteigerte Osteoklastentätigkeit verursacht werden, mit zunehmendem Erfolg eingesetzt. Folgende Entwicklungen der BP sind dafür verantwortlich:

  • Die modernen BP sind heute schon 20.000-mal potenter als das erstzugelassene Präparat.

  • Ihre biochemischen und zellulären Wirkungsmechanismen sind inzwischen aufgeklärt.

  • Sie haben keine Hormonwirkung, sodass sie allen Patienten offen stehen.

  • Sie sind gut verträglich, die Applikation kann oral oder intravenös erfolgen.

  • Sie wurden in multinationalen Studien beispielhaft gründlich geprüft.

  • Sie sind der „Goldstandard“ in der Therapie der Volkskrankheit Osteoporose.

  • Seltene, aber schwerwiegende Nebenwirkungen wie die Kieferosteonekrose oder die akute Niereninsuffizienz können weitgehend vermieden werden.

  • BP haben auch tumorizide Eigenschaften und werden zur Suppression des Tumorwachstums im Knochen eingesetzt.

  • Ihre antiinflammatorische Wirkung wird auch bei der Behandlung von Knochenmarködemen und Knochenschmerzen erfolgreich genutzt.

Abstract

Over the past three decades, the members of the substance group called bisphosphonates (BP) have been employed with growing success to manage osteopathies caused by increased osteoclastic activity. The following developments in BP are responsible:

  • Modern BP are now already 20,000 times more potent than the first preparation approved for use.

  • Their biochemical and cellular mechanisms of action have meanwhile been elucidated.

  • They have no effect on hormones so that they are open for all patients.

  • They are well tolerated and can be administered orally or intravenously.

  • They have admirably been thoroughly studied in multinational trials.

  • They are the “gold standard” in the treatment of osteoporosis, a widespread disease.

  • Rare but serious side effects such as osteonecrosis of the jaw or acute renal insufficiency can be avoided to a large extent.

  • BP also have tumoricidal properties and are used to suppress tumor growth in bones.

  • Their anti-inflammatory activity is also successfully used in the treatment of bone marrow edema and bone pain.

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Authors and Affiliations

  1. Bayerisches Osteoporose-Zentrum, Klinikum der Universität München-Großhadern, Marchioninistraße 15, 81377, München, Deutschland

    R. Bartl

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Zentrum für Chirurgie, Universität Ulm, Ulm, Deutschland

    C. Bartl

  3. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Technische Universität München, München, Deutschland

    R. Gradinger

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Correspondence to R. Bartl.

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Bartl, R., Bartl, C. & Gradinger, R. Einsatz der Bisphosphonate in der Orthopädie und Unfallchirurgie. Orthopäde 37, 595–614 (2008). https://doi.org/10.1007/s00132-008-1280-y

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