Öz
Osteoporoz tedavisinde kullanılan ajanlar genellikle iyi tolere edilir ve oldukça etkindirler. Bisfosfonatlar ve RANKL inhibitörü denosumab gibi antirezorptifler en sık kullanılan osteoporoz ilaçlarıdır. Bu ajanlar postmenopozal osteoporozlu kadınlarda kemik mineral yoğunluğunu arttırırlar ve vertebral kırık (%40-70), vertebra dışı kırık (%25-40) ve kalça kırık (%40-53) riskini azaltırlar. Şiddetli osteoporozu ve yüksek kırık riski olan hastalarda, tek başına bisfosfonatlar kırıklara karşı uzun vadeli koruma sağlayamayabilirler. Bu hastalar için, ardışık tedavi, kemik yapıcı bir ajanla (teriparatid) tedaviye başlanması ve bunu antirezorptiflerin izlemesi daha iyi bir uzun vadeli kırık engellenmesi sağlayabilir ve osteoporoz tedavisinin geleceği için altın standart olmalıdır. Bir hasta için ilaç seçimi tamamen hastayı tedavi edecek klinisyene bağlıdır ve hastanın genel sağlık durumu, tedaviye uyumu, tedavi ajanı tercihi, tedavi ajanlarının risk/ yararları düşünülerek ve ülkelerin sağlık sistemi ve özel koşulları göz önünde bulundurularak, osteoporoz tanı ve tedavi kılavuzlarının önerileri doğrultusunda karar verilir
Anahtar Kelimeler
Kaynakça
- Lorentzon M. Treating osteoporosis to prevent fractures: current concepts and future developments. J Intern Med 2019 Jan.doi 10.1111/joim 12873.
- Kanis JA, Cooper C, Rizzoli R, Reginster JY. Scientific Advisory Board of ESCEO and IOF. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019 Jan; 30(1):3-44 .
- Black DM, Rosen CJ. Clinical Practice. Postmenopausal Osteoporosis. N Engl J Med 2016 Jan 21; 374(3): 254-62.
- Compston J, Cooper A, Cooper C, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 2017;12:43-67.
- Camacho P, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL. AACE/ACE Postmenopausal Osteoporosis CPG. Endocr Pract 2016;22(Suppl 4):1-36.
- Di Fede O, Panzarella V, Mauceri R, et al. The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention. Biomed Res Int 2018 Sep 16;2018:2684924. doi: 10.1155/2018/2684924.
- Silverman S, Kupperman E, Bukata S. Bisphosphonate-related atypical femoral fracture: Managing a rare but serious complication. Cleve Clin J Med 2018 Nov;85(11):885-893.
- Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 2017 Jul;5(7):51323.
- Lewiecki EM. New and emerging concepts in the use of denosumab for the treatment of osteoporosis. Ther Adv Musculoskelet Dis 2018 Nov; 10(11): 209–23.
- Kendler DL, Marin F, Zerbini CAF, et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet 2018 Jan 20;391(10117):230-40.
- Lou S, Lv H, Chen Y, Zhang L, Tang P. Use of combination therapy in the treatment of osteoporosis. BMJ Open 2016 Nov 8;6(11):e012802.
- Leder BZ. Optimizing sequential and combined anabolic and antiresorbtive osteoporosis therapy. JBMR Plus 2018 Feb 27;2(2):62-8.
- Meier C, Uebelhart B, Aubry-Rozier B, Birkhäuser M, Bischoff-Ferrari H, Frey D. Osteoporosis drug treatment: duration and management after discontinuation. A position statement from the Swiss Association against Osteoporosis (SVGO/ASCO). Swiss Med Wkly 2017;147:w14484.
Öz
The drugs that are used in the treatment of osteoporosis are usually well tolerated and highly effective. Antiresorptive drugs, such as the bisphosphonates and the RANKL inhibitor denosumab, are currently the most widely used osteoporosis medications. These drugs increase bone mineral density (BMD) and reduce the risk of vertebral (by 40-70%), nonvertebral (by 25-40%) and hip fractures (by 40-53%) in postmenopausal women with osteoporosis. For patients with severe osteoporosis and high fracture risk, bisphosphonates alone are unlikely to be able to provide long-term protection against fracture and restore BMD. For those patients, sequential treatment, starting with a bonebuilding drug (e.g. teriparatide), followed by an antiresorptive, will likely provide better long-term fracture prevention and should be the golden standard of future osteoporosis treatment. The choice of medical treatment depends totally on the clinician who treats the patient and the decision is made according to the patient’s preferences, adherence to treatment, the health system of the country and the guidelines
Anahtar Kelimeler
Kaynakça
- Lorentzon M. Treating osteoporosis to prevent fractures: current concepts and future developments. J Intern Med 2019 Jan.doi 10.1111/joim 12873.
- Kanis JA, Cooper C, Rizzoli R, Reginster JY. Scientific Advisory Board of ESCEO and IOF. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019 Jan; 30(1):3-44 .
- Black DM, Rosen CJ. Clinical Practice. Postmenopausal Osteoporosis. N Engl J Med 2016 Jan 21; 374(3): 254-62.
- Compston J, Cooper A, Cooper C, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 2017;12:43-67.
- Camacho P, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL. AACE/ACE Postmenopausal Osteoporosis CPG. Endocr Pract 2016;22(Suppl 4):1-36.
- Di Fede O, Panzarella V, Mauceri R, et al. The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention. Biomed Res Int 2018 Sep 16;2018:2684924. doi: 10.1155/2018/2684924.
- Silverman S, Kupperman E, Bukata S. Bisphosphonate-related atypical femoral fracture: Managing a rare but serious complication. Cleve Clin J Med 2018 Nov;85(11):885-893.
- Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 2017 Jul;5(7):51323.
- Lewiecki EM. New and emerging concepts in the use of denosumab for the treatment of osteoporosis. Ther Adv Musculoskelet Dis 2018 Nov; 10(11): 209–23.
- Kendler DL, Marin F, Zerbini CAF, et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet 2018 Jan 20;391(10117):230-40.
- Lou S, Lv H, Chen Y, Zhang L, Tang P. Use of combination therapy in the treatment of osteoporosis. BMJ Open 2016 Nov 8;6(11):e012802.
- Leder BZ. Optimizing sequential and combined anabolic and antiresorbtive osteoporosis therapy. JBMR Plus 2018 Feb 27;2(2):62-8.
- Meier C, Uebelhart B, Aubry-Rozier B, Birkhäuser M, Bischoff-Ferrari H, Frey D. Osteoporosis drug treatment: duration and management after discontinuation. A position statement from the Swiss Association against Osteoporosis (SVGO/ASCO). Swiss Med Wkly 2017;147:w14484.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Ek |
| Yazarlar | |
| Yayımlanma Tarihi | 25 Ekim 2019 |
| Gönderilme Tarihi | 19 Ekim 2018 |
| Yayımlandığı Sayı | Yıl 2019 |
Cited By
Osteoporoz Nedeniyle Bifosfonat Kullanan Hastalarda Erken Evre Osteonekroz Bulgularının ve Ağız Sağlığının Değerlendirilmesi
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi
https://doi.org/10.46237/amusbfd.1141019