I tre farmaci della nota non
sono privi di effetti indesiderati:
l'alendronato può causare o accentuare
esofagite (18,19) particolarmente in donne con
reflusso gastro-esofageo o alterata motilità
esofagea o che assumono FANS o che sono incapaci
di seguire le raccomandazioni del foglietto
illustrativo (compressa presa a digiuno con
abbondante acqua, posizione eretta o seduta per
almeno trenta minuti). Secondo i dati riportati
in alcuni piccoli trial pubblicati in
abstract e un trial comparativo su 515
donne (20), il risedronato risulterebbe meglio
tollerato. È tuttavia necessario tener presente
che i danni esofagei da alendronato non emergono
dai trial, ma dalla più estesa e meno
controllata esperienza post-commercializzazione.
Gli effetti indesiderati del raloxifene sono
correlati al suo meccanismo d'azione: effetti
minori sono le vampate di calore, crampi alle
gambe, edema periferico. L'effetto indesiderato
più serio, peraltro comune agli estrogeni, è
rappresentato dall'incidenza di tromboembolia
venosa, che era dell'1% nelle donne trattate e
dello 0,3% nelle donne che ricevevano un placebo
(4, 5).
1. Black DM, et al.
Randomised trial of effect of alendronate
on risk of fracture in women with existing
vertebral fractures. Lancet 1996;348:1535-41.
2. Eastell R. Drug Therapy:
treatment of postmenopausal osteoporosis. N
Engl J Med 1998;338:736-46.
3. Harris ST, et al. Effects
of risedronate treatment on vertebral and non
vertebral fractures in women with postmenopausal
osteoporosis. JAMA 1999;282:1344-52.
4. Ettinger B, et al.
Reduction of vertebral fracture risk in
postmenopausal women with osteoporosis treated
with raloxifene: results from a 3-year
randomized clinical trial. JAMA
1999;282:637-45.
5. Mc Clung M. Therapy for
fracture prevention. JAMA 1999;282:687-9.
6. Khovidhunkit W, et al.
Clinical effects of raloxifene hydrochloride in
women. Ann Intern Med 1999;130:431-9.
7. McClung M, et al. Effect
of risedronate on hip fracture risk in elderly
women. Hip Intervention Program Study Group. N
Engl J Med. 2001;344:333-40
8. Reginster J, et al.
Randomized trial of the effects of
risedronate on vertebral fractures in women with
established postmenopausal osteoporosis.
Osteop Intern 2000;11:83-91.
9. Willkin T. Changing
perceptions in osteoporosis. BMJ 1999;318:862-5.
10. De Laet CE, et al. Bone
density and risk of hip fracture in men and
women: cross sectional analysis. BMJ
1997;315:221-5.
11. Marshall D, et al.
Meta-analysis of how well measures of bone
mineral density predict occurrence of
osteoporotic fractures. BMJ 1996;312:1254-9.
12. Tinetti ME, et al. A
multifactorial intervention to reduce the risk
of falling among elderly people living in the
community. N Engl J Med 1994;331:821-7.
13. Keen RW. Effects of
lifestyle interventions on bone health. Lancet
1999;354:1923-4.
14. Orwoll E, et al.
Alendronate for the treatment of osteoporosis in
men. N Engl J Med 2000;343:604-10.
15. Wallach S, et al. Effects
of risedronate treatment on bone density and
vertebral fracture in patients on corticosteroid
therapy. Calc Tissue Int 2000;67:277-85.
16. Adachi JD, et al.
Two-year effects of alendronate on bone mineral
density and fracture in patients on
glucocorticoids. Arthritis and Rheumatism 2001,44:
202-11.
17. Adachi JD, et al.
Intermittent etidronate therapy to prevent
corticosteroid-induced osteoporosis. N Engl J
Med 1997;337:382-7.
18. De Groen PC, et al.
Esophagitis associated with the use of
alendronate. N Engl J Med 1996;335:1016-21.
19. Mackay FJ, et al. for the
Drug Safety Research Unit, Southampton. United
Kingdom experience with alendronate and
esophageal reactions. Br J Gen Pract 1998;48:1161-2.
20. Lanza FL, et al.
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gastroduodenal effects of risedronate and
alendronate in postmenopausal women.
Gastroenterology 2000;119:631-8.