Osteoporose unter Langzeitbehandlung mit Glukokortikoiden -Bisphosphonate zur Prävention und Therapie

For various skin diseases long-term administration of glucocorticosteroids is established as therapy of first choice (1). Some of the frequent adverse drug reactions like hyperglycemia and hypertension can be antagonized, thus reducing complications and rate of discontinuation. Regarding osteoporosis, the situation is different. So far estrogens, anabolic steroids, thiazide diuretics, cholecalciferol and calcitonin have been used for prevention and management of glucocorticosteroid-induced osteoporosis. However, studies upon the efficacy of these regimens published so far show conflicting evidence (2-4). Encouraging results of recently published studies prove bisphhosphonates to represent first-line treatment of glucocorticosteroid-induced osteoporosis (5-8). This summary outlines the pathophysiology of glucocorticosteroid-induced osteoporosis, the required diagnostic steps preceding a long-term treatment by glucocorticosteroids and the common measures of osteoporosis prevention. Furthermore mechanisms of the action of bisphosphonates are demonstrated and the results of studies upon different bisphosphonates are discussed.