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06.08.2021 | Osteoporose | Empfehlungen und Stellungnahmen von Fachgesellschaften

Empfehlungen der Deutschen Gesellschaft für Rheumatologie zum Management der Glukokortikoid-induzierten Osteoporose

verfasst von: Jan Leipe, Julia U. Holle, Christiane Weseloh, Alexander Pfeil, Klaus Krüger, die Kommission Pharmakotherapie der Deutschen Gesellschaft für Rheumatologie e. V. (DGRh)

Erschienen in: Zeitschrift für Rheumatologie | Ausgabe 7/2021

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Zusammenfassung

Hintergrund

Glukokortikoide sind von erheblicher therapeutischer Bedeutung bei der Behandlung entzündlicher Erkrankungen, jedoch insbesondere bei langfristiger Anwendung mit Knochenmineraldichteverlust, Osteoporose und Frakturen assoziiert.

Ziel dieser Arbeit

Es sollten Empfehlungen zum Management der Glukokortikoid-induzierten Osteoporose (GIOP) bei erwachsenen Patienten unter Langzeit-Glukokortikoid(GC)-Therapie entwickelt werden.

Methodik

Es wurde eine systematische Literatursuche (SLR) durchgeführt, um die Evidenz für Präventions- und Behandlungsoptionen der GIOP zusammenzufassen. Mithilfe zuvor definierter Fragestellungen wurden, basierend auf SLR und dem Evidenzgrad, Empfehlungen in einem strukturierten Gruppenkonsensprozess erarbeitet.

Ergebnisse

Die Empfehlungen umfassen zunächst die Supplementation mit Kalzium und Vitamin D bei Erwachsenen unter Langzeit-GC-Therapie. Wenn eine spezifische osteologische Therapie angezeigt ist, empfehlen wir als Erstlinientherapie Bisphosphonate oder Denosumab. Bei hohem Frakturrisiko empfehlen wir Teriparatid als primäre spezifische osteologische Therapie. Bei hochgradiger Niereninsuffizienz soll Denosumab (nach Ausschluss renaler Osteopathie) eingesetzt werden und bei Schwangerschaft keine spezifische osteologische Therapie erfolgen. Für Patienten, die das Therapieziel nicht erreicht haben, sollte die Umstellung auf eine andere Klasse spezifischer osteologischer Medikamente erfolgen. Wir empfehlen eine Reevaluation nach einer Therapiedauer von 3 bis 5 Jahren oder nach Beendigung der Langzeit-GC-Therapie.

Fazit

Diese Arbeit soll evidenz- und konsensbasierte Empfehlungen für ein bestmögliches Management der GIOP in Deutschland geben und bei Behandlungsentscheidungen unterstützen.

Nur mit Berechtigung zugänglich

Standardabweichung und Konfidenzintervalle sind zur besseren Lesbarkeit des Manuskripttextes in den Evidenztabellen nachlesbar (Supplement).

Zulassungsstatus, Applikation s. Tab. 1.

Cave keine GIOP-Zulassung.

Zulassungsstatus, Applikation s. Tab. 1.

Fachinformationen Risedronat, Stand 06/2018, Zolendronat, Stand 07/2019.

Fachinformationen Teriparatid, Stand 11/2017.

Fachinformationen Prolia® (Amgen GmbH, Amgen Europe B.V., Breda, Niederlande), Stand 01/2020.

Gemäß DVO-Leitlinie (2017).

z. B. neue Fraktur ≥18 Monate nach Beginn der Behandlung oder signifikanter Rückgang der BMD ≥10 %/Jahr nach 1 Jahr Behandlung.

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Titel: Empfehlungen der Deutschen Gesellschaft für Rheumatologie zum Management der Glukokortikoid-induzierten Osteoporose
verfasst von: Jan Leipe
Julia U. Holle
Christiane Weseloh
Alexander Pfeil
Klaus Krüger
die Kommission Pharmakotherapie der Deutschen Gesellschaft für Rheumatologie e. V. (DGRh)
Publikationsdatum: 06.08.2021
Verlag: Springer Medizin
Schlagwörter: Osteoporose
Bisphosphonate
Osteoporose
Glucocorticoide
Denosumab
Denosumab
Erschienen in: Zeitschrift für Rheumatologie / Ausgabe 7/2021
Print ISSN: 0340-1855
Elektronische ISSN: 1435-1250
DOI: https://doi.org/10.1007/s00393-021-01028-w

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Empfehlungen der Deutschen Gesellschaft für Rheumatologie zum Management der Glukokortikoid-induzierten Osteoporose

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