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Einfluss spezifischer Osteoporosemedikamente auf die Frakturheilung

Influence of specific osteoporosis drugs on fracture healing

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Zusammenfassung

Hintergrund

Zur Behandlung einer gestörten Frakturheilung könnten neben chirurgischen Maßnahmen auch Medikamente gegeben werden. Spezifische Osteoporosemedikamente greifen in den Knochenstoffwechsel ein und werden zur Therapie einer Osteoporose, u. a. nach einer Fragilitätsfraktur, eingesetzt. Denkbar wäre deshalb auch deren Einsatz zur Verbesserung einer gestörten Frakturheilung.

Ziel der Arbeit

Die vorliegende Arbeit stellt die klinisch verfügbaren und in der Zulassung befindlichen spezifischen Osteoporosemedikamente vor und geht der Frage nach, ob diese Substanzen die Frakturheilung im Rahmen einer Osteoporosebehandlung beeinflussen. Ferner wird erörtert, ob eine gestörte Frakturheilung durch deren Einsatz verbessert werden kann.

Material und Methoden

Es wurde eine Literaturrecherche (PubMed) anhand themenbezogener Schlüsselbegriffe durchgeführt. Berücksichtigt wurden präklinische Arbeiten, klinische Studien, Übersichtsarbeiten und Metaanalysen, um einen möglichst umfassenden Stand der Wissenschaft mit klinisch relevantem Bezug darzustellen.

Ergebnisse

Präklinische und klinische Studien zeigen, dass spezifische Osteoporosemedikamente keinen relevanten negativen Einfluss auf die Heilung von Fragilitätsfrakturen haben. Die tendenzielle Verbesserung einer gestörten Frakturheilung wurde den knochenanabolen Substanzen zugeschrieben. Die Studienlage ist jedoch uneinheitlich, und eine Zulassung für diese Anwendung besteht nicht.

Schlussfolgerung

Nach einer Fragilitätsfraktur sollte eine Osteoporose gemäß Leitlinie abgeklärt und ggf. mit spezifischen Osteoporosemedikamenten behandelt werden, da diese die Frakturheilung grundsätzlich nicht beeinträchtigen, aber das Risiko für Folgefrakturen deutlich senken. Eine Zulassung zur Verbesserung der Frakturheilung erfordert weitere Studien.

Abstract

Background

For the treatment of disturbed fracture healing, drugs could be given in addition to surgical procedures. Specific osteoporosis drugs affect the bone metabolism and are used to treat osteoporosis, particularly after a fragility fracture has occurred. Therefore, their use would be conceivable to improve a disturbed fracture healing.

Objective

This article presents the available and upcoming specific osteoporosis drugs and investigates whether these substances affect fracture healing in the context of osteoporosis. Furthermore, it is discussed whether disturbed fracture healing can be improved by the use of these substances.

Material and methods

A literature search (PubMed) was conducted using key terms. Preclinical studies, clinical studies, reviews and meta-analyses were considered in order to present the current knowledge in a clinically relevant context.

Results

Preclinical and clinical studies show that specific osteoporosis drugs have no relevant negative impact on the healing of fragility fractures. A tendency to improve a disturbed fracture healing was attributed to bone anabolic substances; however, studies are inconsistent and there is no approval for this application.

Conclusion

Following a fragility fracture, osteoporosis should be diagnosed according to the guidelines and, if necessary, treated with specific osteoporosis drugs, since in principle they do not impair fracture healing but significantly reduce the risk of subsequent fractures. Approval to improve fracture healing requires further investigations.

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Authors and Affiliations

  1. Institut für Molekulare Muskuloskelettale Forschung, Klinikum der Ludwig-Maximilians-Universität München, Fraunhoferstr. 20, 82152, München-Martinsried, Deutschland

    Eric Hesse

  2. Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    Carl Neuerburg, Christian Kammerlander, Ulla Stumpf & Wolfgang Böcker

  3. Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität, Münster, Deutschland

    Richard Stange

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Correspondence to Eric Hesse.

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Interessenkonflikt

E. Hesse ist Referent und/oder Berater für die Firmen Amgen, Eli Lilly, UCB, Binding Site, Clementia und AgNovos. C. Neuerburg ist Referent und/oder Berater für die Firmen Amgen, Eli Lilly, UCB, AgNovos und AOTrauma. C. Kammerlander ist Referent und/oder Berater für die Firmen Eli Lilly, Johnsen & Johnsen und Peter Brehm. U. Stumpf ist Referentin und/oder Beraterin für die Firmen Amgen, Eli Lilly und AgNovos. R. Stange ist Referent und/oder Berater für die Firmen Amgen, Eli Lilly und AgNovos. W. Böcker ist Referent und/oder Berater für die Firmen Amgen, Eli Lilly und UCB.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hesse, E., Neuerburg, C., Kammerlander, C. et al. Einfluss spezifischer Osteoporosemedikamente auf die Frakturheilung. Unfallchirurg 122, 506–511 (2019). https://doi.org/10.1007/s00113-019-0669-x

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