DVO Guideline 2009 for Prevention, Diagnosis and Therapy of ...

70 DVO Guideline Osteoporosis 2009
Table 5 Medical Therapy of Osteoporosis
Medicinal
product
trade name
Alendronate
Fosamax ®
different generic
products
Ibandronate
Bonviva ®
Oestrogens
Various medicinal
products
Parathyroid hormone
(PTH 1–84)
Preotact ®
Dosage
Extra-skeletal additional
effects
10 mg 1 x per day p. o.
70 mg 1 x per week p. o.
70 mg 1 x per week p. o. with
2800 IU colecalciferol (Fosavance ®
2800)
70 mg 1 x per week p. o. with
5600 IU colecalciferol (Fosavance ®
5600)
150 mg 1 x per month p. o.
3 mg every 3 months i. v.
Acc. to ifap index approval
“for prevention of osteoporosis
for post- menopausal women with
high fracture risk who show incompatibility
or contraindications for
other drugs for osteoporosis prevention”
Additional Effects: See full-text version
of 2006
100 μg daily s. c.
Maximum treatment time is
24 months
Side effects Contraindications
● Esophagitis
● Minor hypocalcaemia
● Minor hypophosphatemia
● Atrial fibrillation (inconsistent
data) (E147, E158)
● Osteonecrosis of the jaw
(very rare) (E158)
● Pain in limb, bone, joint
(normally temporary)
● Acute phase response (more
rare than after zoledronate)
(E158)
● Osteonecrosis of the jaw
(very rare) (E158)
● Hypercalcaemia
● Hypercalciuria
● Nausea, vomiting
● Headache
● Dizziness
● Diseases of the oesophagus and other reasons for a
delay of the oesophageal emptying as strictures or achalasia
● Impossibility to keep to intake necessities, e. g. inability
to stand or to sit upright for at least 30 minutes
● Hypocalcaemia
● Pregnancy, lactation
● Renal insufficiency grades III (partly), IV and V (creatinine
clearance < 35 ml/min) (E158)
● In case of 10 mg dose: Severe gastrointestinal
diseases within the last year (e. g. peptic ulceration,
active bleeding or surgery at the upper gastrointestinal
tract). Here one has to be extremely careful in the case
of a 70 mg dose.
● Hypocalcaemia
● Pregnancy, lactation
● Renal insufficiency grades IV and V (creatinine
clearance < 30 ml/min) (E158)
● Suspicion of, or existing uterine carcinoma or breast
cancer
● Severe liver diseases
● Jaundice, idiopathic jaundice in medical history
● Thrombophlebitis and thromboembolic processes;
existing or in medical history
● Unexplained vaginal bleedings
● Sickle cell anaemia
● Otosclerosis
● Present or recent arterial thromboembolic diseases
(above all angina pectoris, myocardial infarction)
● Porphyria
Furthermore, oestrogen alone therapy is absolutely contraindicated
(without progesterone supplement) for
women with intact uterus due to the high risk of an endometrial
carcinoma. Personal or family history of breast
cancer is not generally regarded as a strict contraindication.
● Current hypercalcaemia
● Pregnancy, lactation
● Renal insufficiency grades IV and V (creatinine
clearance < 30 ml/min)
● Metabolic bone diseases (e. g. hyperparathyroidism
and Paget’s disease) with the exception of primary osteoporosis
● Unexplained increase in alkaline phosphatase
● Severely impaired liver function
● Previous radiotherapy of the skeleton
Osteologie 1/2011 © Schattauer 2011