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Osteoporosis And Polypharmacy

M Gosch, Michael Jeske, Christian Kammerlander, Tobias Roth
Published 2012 · Medicine
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Osteoporosis is very common in elderly patients. Despite the severe health-related consequences for individual patients and the socioeconomic costs caused by osteoporotic fractures, treatment rates are still low. Due to drug interactions and patient compliance, polypharmacy is often mentioned as a reason for undertreatment. Several drugs have a direct or indirect effect on bone metabolism. The present paper discusses the risk of interactions of anti-osteoporotic drugs (oral and parenteral bisphosphonates, raloxifene, strontium ranelate, teriparatide, and denosumab) with other common medications in elderly patients and their impact on bone metabolism and fracture risk. In summary, the number and risk of drug interactions of all common anti-osteoporotic drugs are small and clinically rather irrelevant. However, patients with a polypharmacy are at a higher risk of fractures and should receive osteoporosis treatment, if indicated.ZusammenfassungOsteoporose hat eine hohe Prävalenz bei älteren Patienten. Trotz der enormen individuellen Folgen für die Betroffenen und die hohen sozioökonomischen Kosten osteoporotischer Frakturen sind die Therapieraten weiterhin sehr gering. Als Begründung wird immer wieder die Polypharmazie genannt, insbesondere im Hinblick auf mögliche Medikamenteninteraktionen sowie die Compliance. Zahlreiche Medikamente haben einen direkten oder indirekten Einfluss auf den Knochenmetabolismus. Im vorliegenden Review wird die Bedeutung möglicher Interaktionen diskutiert sowie das Frakturrisiko im Rahmen einer Polypharmazie dargestellt. Einerseits zeigt sich, dass das Interaktionspotenzial der zugelassenen Osteoporosemedikamente gering ist. Andererseits haben Patienten mit einer Polypharmazie ein erhöhtes Frakturrisiko und sollten eine Osteoporosetherapie erhalten, wenn diese indiziert ist.
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