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FARMACI DEL METABOLISMO OSSEO
Difosfonati: inibiscono il riassorbimento osseo da parte degli osteoclasti. Da assumere con un bicchiere di acqua di fonte almeno 30’ prima di ogni altra bevanda o cibo. Per la possibilità di provocare ipocalcemia e distocia è preferibile non utilizzarli in gravidanza. Non si hanno dati sull’uso in allattamento.
Calcitonina: ormone secreto dalle cellule “C” della tiroide. Agisce inibendo direttamente l’attività degli osteoclasti. La sua attività è testimoniata da diminuzione della calcemia, fosfatasi alcalina e idrossiprolina urinaria delle 24 ore. In commercio è utilizzata la calcitonina di salmone per il trattamento dell´osteoporosi postmenopausale stabilizzata. La dose raccomandata per somministrazione endonasale è di 200 UI (1 buff)/die. Si raccomanda di associare il trattamento di calcitonina per somministrazione endonasale con un adeguato apporto di calcio e di vitamina D. Mancano studi per l’uso in gravidanza e allattamento.
Salcatonina: farmaco realizzato per sintesi in laboratorio, possiede un’azione simile alla calcitonina inibendo l’attività osteoclastica. Utilizzata nella terapia della Malattia di Paget, Osteoporosi e Morbo di Sudeck.
Calcitriolo: o 1,25-diidrossicolecalciferolo è la forma attiva del colecalciferolo (Vit D3 a sua volta sintetizzata per trasformazione del colesterolo a livello cutaneo esposto ai raggi UVA). Il calcitriolo è sintetizzato a livello renale per idrossilazione del calcidiolo sotto lo stmolo del paratormone e prolattina ed in risposta a bassi livelli di calcemia e fosfatemia. Il calcitriolo agisce favorendo l’assorbimento del calcio e del fosfato a livello intestinale e renale e inibendo il rilascio di calcitonina. Non sono stati determinati criteri di sicurezza per l’uso del calcitriolo in gravidanza. Non sono stati effettuati studi controllati su soggetti umani circa l’effetto del calcitriolo sullo sviluppo fetale nel corso della gravidanza. La somministrazione di calcitriolo a dosi eccessive e prolungate potrebbe provocare ipercalcemia con crisi ipertensive e aritmie cardiache materne e fetali.
Il calcitriolo esogeno può passare nel latte materno.
Diidrotachisterolo (Vit D4): steroide di sintesi (9,10-sec-5,7,22-Ergostatrien-3-B-olo), analogo alla vitamina D che a differenza della Vit D2 (ergocalciferolo) e della Vit D3 (Colecalciferolo) non richiede idrossilazione renale per essere attivo.
Raloxifene: farmaco appartenente alla categoria dei SERM (Selective Estrogen Receptor Modulators, modulatori selettivi dei recettori estrogenici). Sono molecole in grado di agire come estrogeno-agoniste o antagoniste, in quanto possono agire al pari degli estrogeni in alcuni organi (ossa) e, al contrario, contrastare l’azione degli estrogeni in altri organi (mammella). Riduce il rischio ormono-dipendente delle fratture vertebrali non traumatiche nelle donne in postmenopausa e sembra avere un’azione positiva nella prevenzione del cancro mammario estrogeno-dipendente. Effetti collaterali importanti sono il rischio di trombosi venosa profonda, hot flashes, ipertensione e insonnia. Assolutamente controindicato in gravidanza e allattamento.
Tab. 16 bis – Farmaci del metabolismo osseo
Alendronato (Alendros cpr, Fosamaxcpr)
Clodronato (Clodronato fl) Pamidronato fl ev in flebo
Ipocalcemia materna e fetale
Distocia del parto
Calcitonina Sandoz fl,
Calcitriolo cps, Zemplar cps
Raloxifene (Evista cpr 60 mg, Optruma cpr 60 mg: una compressa al dì)
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