Glukokortikoidinduzierte Osteoporose (GIO)

Abstract

Patients on long-term glucocorticoid therapy are prone to osteoporosis, and bisphosphonates are considered the treatment of choice for prevention of fractures. However, adherence to oral bisphosphonate treatment is suboptimal. In the study discussed here, the effectiveness of 5 mg intravenous infusion of zoledronic acid was compared to 5 mg oral risedronate for prevention and treatment of glucocorticoid-induced osteoporosis. The primary endpoint was percentage change from baseline in lumbar spine bone mineral density. The authors were able to show that a single 5 mg intravenous infusion of zoledronic acid is non-inferior and possibly more effective, than is 5 mg of oral risedronate daily, which may offer an advantage to patients on long-term glucocorticoid therapy. In another study in patients with glucocorticoid-induced osteoporosis, the effects of teriparatide 20 μg daily subcutaneously were compared to alendronate 10 mg daily orally. At 18 months, among men and pre- and postmenopausal women with glucocorticoid-induced osteoporosis, lumbar spine BMD increased more in patients receiving teriparatide compared to alendronate. Fewer vertebral fractures occurred in teriparatide-treated men and postmenopausal women, whereas no such fractures were observed in premenopausal women. No differences were shown regarding non-vertebral fractures. Thus, teriparatide proved to be efficacious in preventing glucocorticoid-induced osteoporosis, independent of gender and menopausal status.