[Fluorides and bisphosphonates in the treatment of osteoporosis].
The therapeutic aim in osteoporosis to maintain or increase bone mass can be achieved by inhibition of osteoclastic resorption (antiresorptive treatment), stimulation of osteoblastic formation (anabolic treatment), or a combination of both strategies. Antiresorptive therapy of osteoporosis with the nitrogen-containing bisphosphonates alendronate and risedronate is regarded today as evidence-based medicine. A significant reduction in the number of patients with new vertebral fractures has been documented already after 1 year. Anabolic therapy with fluoride was studied less extensively. The low price of fluoride salts and the lack of a patent protection may have contributed to this deficit in large studies. However, several recent medium-sized trials with a low-dose fluoride regimen consistently show a continuous increase in bone density and also a decrease in the rate of new fracture events. In our own pilot study with intermittent etidronate/fluoride therapy, we found significantly additive effects on bone mineral density. A larger trial with this therapeutic strategy using fractures as the primary endpoint would be of great interest.
Ringe
J D
JD
Medizinische Klinik 4, Klinikum Leverkusen, Akademisches Lehrkrankenhaus der Universität zu Köln, 51375 Leverkusen. ringe@klinikum-lev.de
D000368:Aged; D015519:Bone Density; D001862:Bone Resorption; D002136:Calcium, Dietary / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D004164:Diphosphonates / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D012968:Etidronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005459:Fluorides / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D010006:Osteoblasts / Q000187:drug effects; D010024:Osteoporosis / Q000188:drug therapy*; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy; D010865:Pilot Projects; D000068296:Risedronic Acid; D016103:Spinal Fractures / Q000517:prevention & control; D013997:Time Factors; D014807:Vitamin D / Q000008:administration & dosage / Q000627:therapeutic use
D002136:Calcium, Dietary; D004164:Diphosphonates; D014807:Vitamin D; D000068296:Risedronic Acid; D012968:Etidronic Acid; D005459:Fluorides
Fluoride und Bisphosphonate in der Therapie der Osteoporose.