Skip to main content
Top
Gepubliceerd in: Tijdschrift voor Gerontologie en Geriatrie 5/2008

01-10-2008 | Artikel

Behandeling van osteoporose bij ouderen: wat is de evidence?

Auteur: Dr. H. J. J. Verhaar

Gepubliceerd in: Tijdschrift voor Gerontologie en Geriatrie | Uitgave 5/2008

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Samenvatting

Veel ouderen, vooral vrouwen, en hun artsen zien osteoporose nog steeds als een natuurlijk onderdeel van het ouder worden, in plaats van een te voorkomen of behandelbare medische aandoening. Hoogteverlies, hyperkyfose, rugpijn en fracturen worden geaccepteerd als een gevolg van het ouder worden. Een andere barrière voor het instellen van een behandeling is het idee dat het te laat is om daarmee te beginnen in een laat stadium van de ziekte. Hoewel de meeste onderzoeken naar fractuurreductie met medicatie niet waren ontworpen voor de ‘geriatrische’ populatie, was de gemiddelde leeftijd van de deelnemers aan de meeste klinische trials wel rond de 70 jaar. In alle grote onderzoeken kregen patiënten ook steeds calcium- en vitamine-D-suppletie. Uit de beschreven vergelijking van farmacologische opties blijkt dat de arts tegenwoordig de keuze heeft uit meerdere, bewezen effectieve middelen ter preventie van osteoporotische fracturen bij postmenopauzale vrouwen met een verhoogd fractuurrisico. Er zijn nu antifractuurgegevens bekend van calcium/vitamine D, raloxifene, bisfosfonaten, strontiumranelaat en parathormoon. Bisfosfonaten en strontiumranelaat zijn beide goede keuzes voor eerstelijns- of tweedelijnsbehandeling, terwijl parathormoon vooralsnog alleen als tweedelijnsbehandeling van osteoporose bij ouderen kan worden ingezet.
Literatuur
1.
go back to reference Hegeman JH, Willemsen G, van Nieuwpoort J, Kreeftenberg HG, van der Veer E, Slaets JP, ten Duis HJ. Doeltreffende opsporing van osteoporose in de Fractuur- en osteoporosepolikliniek in Groningen; analyse na de eerste 100 patienten. Ned Tijdschr Geneeskd 2004; 148: 2180-5. Hegeman JH, Willemsen G, van Nieuwpoort J, Kreeftenberg HG, van der Veer E, Slaets JP, ten Duis HJ. Doeltreffende opsporing van osteoporose in de Fractuur- en osteoporosepolikliniek in Groningen; analyse na de eerste 100 patienten. Ned Tijdschr Geneeskd 2004; 148: 2180-5.
2.
go back to reference Christiansen C. Consensus development conference: diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 1993; 94: 646-50. Christiansen C. Consensus development conference: diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 1993; 94: 646-50.
3.
go back to reference Lips P, Courpron P, Meunier PJ. Mean wall thickness in trabecular bone packets in the human iliac crest: changes with age. Calcif Tissue Res 1978; 26: 13-7. Lips P, Courpron P, Meunier PJ. Mean wall thickness in trabecular bone packets in the human iliac crest: changes with age. Calcif Tissue Res 1978; 26: 13-7.
4.
go back to reference Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women. Osteoporos Int 2008; 19(4): 385-97. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women. Osteoporos Int 2008; 19(4): 385-97.
5.
go back to reference Grossman J, Maclean CH. Quality indicators for the care of osteoporosis in vulnerable elders. J Am Geriatr Soc 2007; 55(suppl 2): S392-402. Grossman J, Maclean CH. Quality indicators for the care of osteoporosis in vulnerable elders. J Am Geriatr Soc 2007; 55(suppl 2): S392-402.
6.
go back to reference Boonen S, Vanderschueren D, Haentjens P, Lips P. Calcium and vitamin D in the prevention and treatment of osteoporosis - a clinical update. J Intern Med 2006 Jun;259(6):539-52. Boonen S, Vanderschueren D, Haentjens P, Lips P. Calcium and vitamin D in the prevention and treatment of osteoporosis - a clinical update. J Intern Med 2006 Jun;259(6):539-52.
7.
go back to reference Tang BMP, Eslick GD, Nowson C, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007; 370: 657-66. Tang BMP, Eslick GD, Nowson C, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007; 370: 657-66.
8.
go back to reference Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 2007; 92(4): 1415-23. Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 2007; 92(4): 1415-23.
9.
go back to reference Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 2008; 336: 262-266. Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 2008; 336: 262-266.
10.
go back to reference Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB. Effect of Vitamin D on falls: a meta-analysis. JAMA 2004 Apr 28;291(16):1999-2006. Review. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB. Effect of Vitamin D on falls: a meta-analysis. JAMA 2004 Apr 28;291(16):1999-2006. Review.
11.
go back to reference Bischoff-Ferrari HA, Willett WC, Wong JB, Giovanucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005; 293(18): 2257-64. Review. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovanucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005; 293(18): 2257-64. Review.
12.
go back to reference Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992; 327(23): 1637-42. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992; 327(23): 1637-42.
13.
go back to reference Lips P, Graafmans WC, Ooms ME, Bezemer PD, Bouter LM. Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 1996; 124(4): 400-6. Lips P, Graafmans WC, Ooms ME, Bezemer PD, Bouter LM. Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 1996; 124(4): 400-6.
14.
go back to reference Zarowitz BJ, Stefanicci R, Hollenack K, et al. The application of evidence-based principles of care in older persons (issue 1): management of osteoporosis. J Am Med Dir Assoc 2006; 7: 102-8. Zarowitz BJ, Stefanicci R, Hollenack K, et al. The application of evidence-based principles of care in older persons (issue 1): management of osteoporosis. J Am Med Dir Assoc 2006; 7: 102-8.
15.
go back to reference Alvarez MJM, Diaz-Curiel M. Pharmacological treatment of osteoporosis for people over 70. Aging Clin Exp Res 2007; 19: 246-54. Alvarez MJM, Diaz-Curiel M. Pharmacological treatment of osteoporosis for people over 70. Aging Clin Exp Res 2007; 19: 246-54.
16.
go back to reference Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral. Lancet 1996; 348: 1535-41. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral. Lancet 1996; 348: 1535-41.
17.
go back to reference Cummings SR, Black DM, Thompson DE. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280: 2077-82. Cummings SR, Black DM, Thompson DE. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280: 2077-82.
18.
go back to reference Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 1999 Oct 13;282(14):1344-52. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 1999 Oct 13;282(14):1344-52.
19.
go back to reference McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 2001; 344: 333-40. McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 2001; 344: 333-40.
20.
go back to reference Cranney A, Guyatt G, Griffith L, et al. IX: Summery of meta-analyses of therapies for postmenopausal osteoporosis. Endocrine Reviews 2002; 23: 570–578. Cranney A, Guyatt G, Griffith L, et al. IX: Summery of meta-analyses of therapies for postmenopausal osteoporosis. Endocrine Reviews 2002; 23: 570–578.
21.
go back to reference Boonen S, Laan RF, Barton IP, Watts NB. Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies. Osteoporos Int 2005; 16(10): 1291-8. Boonen S, Laan RF, Barton IP, Watts NB. Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies. Osteoporos Int 2005; 16(10): 1291-8.
22.
go back to reference Hochberg MC, Thompson DE, Black D. The effect of alendronate on age-specific incidence of key osteoporotic fractures. Bone 2001; 28 (suppl 5): P576S. (Joint meeting of the International Bone and Mineral Society and the European Calcified Tissue Society, June 2001, Madrid, Spain.) Hochberg MC, Thompson DE, Black D. The effect of alendronate on age-specific incidence of key osteoporotic fractures. Bone 2001; 28 (suppl 5): P576S. (Joint meeting of the International Bone and Mineral Society and the European Calcified Tissue Society, June 2001, Madrid, Spain.)
23.
go back to reference Boonen S, McClung MR, Eastel R, et al. Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women aged 80 and older: Implications for use of antiresorptive agents in the old and oldest old. J Am Geriatr Soc 2004; 52: 1832-9. Boonen S, McClung MR, Eastel R, et al. Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women aged 80 and older: Implications for use of antiresorptive agents in the old and oldest old. J Am Geriatr Soc 2004; 52: 1832-9.
24.
go back to reference Sato Y, Kanoko K, Satoh K, Iwamoto J. The prevention of hip fracture with risedronate and ergocalciferol plus calcium supplementation in elderly women with Alzheimer disease: a randomized controlled trial. Arch Intern Med 2005; 165: 1737-42. Sato Y, Kanoko K, Satoh K, Iwamoto J. The prevention of hip fracture with risedronate and ergocalciferol plus calcium supplementation in elderly women with Alzheimer disease: a randomized controlled trial. Arch Intern Med 2005; 165: 1737-42.
25.
go back to reference Sato Y, Kanoko K, Satoh K, Iwamoto J. Risedronate sodium therapy for prevention of hip fracture after stroke in elderly women. Neurol 2005; 64: 811-816. Sato Y, Kanoko K, Satoh K, Iwamoto J. Risedronate sodium therapy for prevention of hip fracture after stroke in elderly women. Neurol 2005; 64: 811-816.
26.
go back to reference Sato Y, Kanoko K, Satoh K, Iwamoto J. Risedronate sodium therapy for prevention of hip fracture in men 65 years or older after stroke. Arch Intern Med 2005; 165: 1743-8. Sato Y, Kanoko K, Satoh K, Iwamoto J. Risedronate sodium therapy for prevention of hip fracture in men 65 years or older after stroke. Arch Intern Med 2005; 165: 1743-8.
27.
go back to reference Sato Y, Honda Y, Iwamoto J. Risedronate and ergocalciferol prevent hip fracture in elderly men with Parkinson disease. Neurol 2007; 68: 911-915. Sato Y, Honda Y, Iwamoto J. Risedronate and ergocalciferol prevent hip fracture in elderly men with Parkinson disease. Neurol 2007; 68: 911-915.
28.
go back to reference Fleurence RL, Iglesias CP, Johnson JM. The cost effectiveness of bisphosphonates for the prevention and treatment of osteoporosis. A structured review of the literature. Pharmacoeconomics 2007; 25: 913-33. Fleurence RL, Iglesias CP, Johnson JM. The cost effectiveness of bisphosphonates for the prevention and treatment of osteoporosis. A structured review of the literature. Pharmacoeconomics 2007; 25: 913-33.
29.
go back to reference Schousboe JT, Taylor BC, Fink HA, et al. Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA 2007; 298: 629-37. Schousboe JT, Taylor BC, Fink HA, et al. Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA 2007; 298: 629-37.
30.
go back to reference Chesnut III CH, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004; 19: 1241-9. Chesnut III CH, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004; 19: 1241-9.
31.
go back to reference Stakkestad JA, Benevolenskaya LI, Stepan JJ, Skag A, Nordby A, Oefjord E, et al. Intravenous ibandronate injections given every three months: a new treatment option to prevent bone loss in postmenopausal women. Ibandronate Intravenous Study Group. Ann Rheum Dis 2003; 62: 969-75. Stakkestad JA, Benevolenskaya LI, Stepan JJ, Skag A, Nordby A, Oefjord E, et al. Intravenous ibandronate injections given every three months: a new treatment option to prevent bone loss in postmenopausal women. Ibandronate Intravenous Study Group. Ann Rheum Dis 2003; 62: 969-75.
32.
go back to reference Chesnut CH, Ettinger MP, Miller PD, Baylink DJ, Emkey R, Harris ST, et al. Ibandronate produces significant, similar antifracture efficacy in North American and European women: new clinical findings from BONE. Curr Med Res Opin 2005; 21:391-401. Chesnut CH, Ettinger MP, Miller PD, Baylink DJ, Emkey R, Harris ST, et al. Ibandronate produces significant, similar antifracture efficacy in North American and European women: new clinical findings from BONE. Curr Med Res Opin 2005; 21:391-401.
33.
go back to reference Delmas PD, Recker RR, Chesnut 3rd CH, Skag A, Stakkestad JA, Emkey R, et al. Daily and intermittent oral ibandronate normalize bone turnover and provide significant reduction in vertebral fracture risk: results from the BONE study. Osteoporos Int 2004;15:792-8. Delmas PD, Recker RR, Chesnut 3rd CH, Skag A, Stakkestad JA, Emkey R, et al. Daily and intermittent oral ibandronate normalize bone turnover and provide significant reduction in vertebral fracture risk: results from the BONE study. Osteoporos Int 2004;15:792-8.
34.
go back to reference Compston J. Treatments for osteoporosis – looking beyond the HORIZON. N Engl J Med 2007;356:1878-80. Compston J. Treatments for osteoporosis – looking beyond the HORIZON. N Engl J Med 2007;356:1878-80.
35.
go back to reference Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. HORIZON Pivotal Fracture Trial. N Engl J Med 2007; 356: 1809-22. Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. HORIZON Pivotal Fracture Trial. N Engl J Med 2007; 356: 1809-22.
36.
go back to reference Lyles KW, Colón-Emeric CS, Jay S, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007; 357(18): 1799-809. Lyles KW, Colón-Emeric CS, Jay S, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007; 357(18): 1799-809.
37.
go back to reference Meunier PJ, Roux C, Seeman E, et al. The effects of strontium ranelate on the risk of vertebral fractures in women with post-menopausal osteoporosis. N Engl J Med 2004; 350: 459-68. Meunier PJ, Roux C, Seeman E, et al. The effects of strontium ranelate on the risk of vertebral fractures in women with post-menopausal osteoporosis. N Engl J Med 2004; 350: 459-68.
38.
go back to reference Reginster JY, Seeman E, Vernejoul MC de, et al. Strontium ranelate reduces the risk of nonvertebral fractures in post-menopausal women with osteoporosis: Treatment of Periferal Osteoporosis (TROPOS) study. J Clin End Metab 2005; 90: 2816-22. Reginster JY, Seeman E, Vernejoul MC de, et al. Strontium ranelate reduces the risk of nonvertebral fractures in post-menopausal women with osteoporosis: Treatment of Periferal Osteoporosis (TROPOS) study. J Clin End Metab 2005; 90: 2816-22.
39.
go back to reference Seeman E, Vellas B, Benhamou C, Aquino JP, Semler J, Kaufman JM, Hoszowski K, Varela AR, Fiore C, Brixen K, Reginster JY, Boonen S. Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older. J Bone Miner Res 2006; 21(7): 1113-20. Seeman E, Vellas B, Benhamou C, Aquino JP, Semler J, Kaufman JM, Hoszowski K, Varela AR, Fiore C, Brixen K, Reginster JY, Boonen S. Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older. J Bone Miner Res 2006; 21(7): 1113-20.
40.
go back to reference Neer RM, Arnoud CD, Zanchetti JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434-41. Neer RM, Arnoud CD, Zanchetti JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434-41.
41.
go back to reference Greenspan SL, Bone HG, Ettinger MP, et al. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis. Ann Intern Med 2007; 146: 326-339. Greenspan SL, Bone HG, Ettinger MP, et al. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis. Ann Intern Med 2007; 146: 326-339.
42.
go back to reference Marcus R, Wang O, Satterwhite J, et al. The skeletal response to teriparatide is largely independent of age, initial bone mineral density, and prevalent vertebral fractures in postmenopausal women with osteoporosis. J Bone Miner Res 2003; 18: 18-23. Marcus R, Wang O, Satterwhite J, et al. The skeletal response to teriparatide is largely independent of age, initial bone mineral density, and prevalent vertebral fractures in postmenopausal women with osteoporosis. J Bone Miner Res 2003; 18: 18-23.
43.
go back to reference Boonen S, Marin F, Mellstrom D, Xie L, Desaiah D, Krege JH, Rosen CJ. Safety and efficacy of teriparatide in elderly women with established osteoporosis: bone anabolic therapy from a geriatric perspective. J Am Geriatr Soc 2006; 54(5): 782-9. Boonen S, Marin F, Mellstrom D, Xie L, Desaiah D, Krege JH, Rosen CJ. Safety and efficacy of teriparatide in elderly women with established osteoporosis: bone anabolic therapy from a geriatric perspective. J Am Geriatr Soc 2006; 54(5): 782-9.
44.
go back to reference Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999; 282: 637-45. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999; 282: 637-45.
45.
go back to reference Miller RG. Osteoporosis in postmenopausal women. Therapy options across a wide range of risk for fracture. Geriatrics 2006; 61: 24-30. Miller RG. Osteoporosis in postmenopausal women. Therapy options across a wide range of risk for fracture. Geriatrics 2006; 61: 24-30.
Metagegevens
Titel
Behandeling van osteoporose bij ouderen: wat is de evidence?
Auteur
Dr. H. J. J. Verhaar
Publicatiedatum
01-10-2008
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Tijdschrift voor Gerontologie en Geriatrie / Uitgave 5/2008
Print ISSN: 0167-9228
Elektronisch ISSN: 1875-6832
DOI
https://doi.org/10.1007/BF03078150

Andere artikelen Uitgave 5/2008

Tijdschrift voor Gerontologie en Geriatrie 5/2008 Naar de uitgave

Congresagenda

Congresagenda

Signalementen

Signalementen