A cura di Alessandra Russo. Specialista in Tossicologia Medica. Messina
Sulla rivista Australian Prescriber è stato pubblicato un articolo (1) relativo ai farmaci per l’osteoporosi.
Di seguito si riporta in tabella un’ampia sintesi degli eventi avversi associati a tali farmaci.
|
Farmaci |
Eventi avversi comuni |
Eventi avversi rari |
|
Bifosfonati per via orale (2-9) |
Ipocalcemia Reazioni a livello del tratto gastrointestinale superiore (reflusso gastro-esofageo, esofagite erosiva) |
Osteonecrosi della mascella/mandibola Fratture femorali atipiche |
|
Bifosfonati per via endovenosa |
Ipocalcemia Sintomi simil-influenzali |
Osteonecrosi della mascella/mandibola Fratture femorali atipiche |
|
Denosumab (10-14) |
Ipocalcemia Reazioni a livello del sito di iniezione Fratture vertebrali senza trauma dopo interruzione del denosumab |
Osteonecrosi della mascella/mandibola Fratture femorali atipiche |
|
Raloxifene (15) |
Vampate di calore Tromboembolismo venoso |
Stroke |
|
Teriparatide (16,17) |
Ipercalcemia Reazioni a livello del sito di iniezione |
Rischio teorico di osteosarcoma |
|
Romosozumab (18-20) |
Reazioni a livello del sito di iniezione |
Possibile aumento del rischio di eventi cardiovascolari maggiori (infarto del miocardio, stroke) Osteonecrosi della mascella/mandibola Fratture femorali atipiche |
Bibliografia
- Aust Prescr 2022; 45: 150-7
- Robinson DE, et al. Safety of oral bisphosphonates in moderate-to-severe chronic kidney disease: a binational cohort analysis. J Bone Miner Res 2021; 36: 820-32.
- Nayak S, Greenspan SL. A systematic review and metaanalysis of the effect of bisphosphonate drug holidays on bone mineral density and osteoporotic fracture risk. Osteoporos Int 2019; 30: 705-20.
- Black DM, et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 2012; 27: 243-54.
- Black DM, et al.; FLEX Research Group. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 2006; 296: 2927-38.
- Bone HG, et al.; Alendronate Phase III Osteoporosis Treatment Study Group. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004; 350: 1189-99.
- Harris ST, et al.; Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999; 282: 1344-52.
- Schwartz AV, et al.; FLEX Research Group. Efficacy of continued alendronate for fractures in women with and without prevalent vertebral fracture: the FLEX trial. J Bone Miner Res 2010; 25: 976-82.
- Watts NB, et al. Fracture risk remains reduced one year after discontinuation of risedronate. Osteoporos Int 2008; 19: 365-72.
- Tsourdi E, et al. Discontinuation of denosumab therapy for osteoporosis: a systematic review and position statement by ECTS. Bone 2017; 105: 11-7.
- Tripto-Shkolnik L, et al. Fracture incidence after denosumab discontinuation: real-world data from a large healthcare provider. Bone 2020; 130: 115150.ù
- Burckhardt P, et al; The Swiss Denosumab Study Group. Fractures after denosumab discontinuation: a retrospective study of 797 cases. J Bone Miner Res 2021; 36: 1717-28.
- Lyu H, et al. Delayed denosumab injections and fracture risk among patients with osteoporosis: a population-based cohort study. Ann Intern Med 2020; 173: 516-26.
- Cummings SR, et al. Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension. J Bone Miner Res 2018; 33: 190-8.
- D’Amelio P, Isaia GC. The use of raloxifene in osteoporosis treatment. Expert Opin Pharmacother 2013; 14: 949-56.
- Díez-Pérez A, et al. Effects of teriparatide on hip and upper limb fractures in patients with osteoporosis: a systematic review and meta-analysis. Bone 2019; 120: 1-8.
- Minisola S, et al. Update on the safety and efficacy of teriparatide in the treatment of osteoporosis. Ther Adv Musculoskel Dis 2019; 11: 1759720X19877994.
- Cosman F, et al. Romosozumab treatment in postmenopausal women with osteoporosis. N Engl J Med 2016; 375: 1532-43.
- Saag KG, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med 2017; 377: 1417-27.
- Cosman F, et al. Romosozumab and antiresorptive treatment: the importance of treatment sequence. Osteoporos Int 2022; 33: 1243-56.