[Perspectives on therapy with diphosphonates in non-malignant diseases]

Diphosphonates inhibit bone resorption. This therapeutic effect found early recognition in the treatment of Paget's disease. The favorable long-term effect of the substance gives rise to a shorter therapy period. Due to increased fracture incidence as a result of osteoidosis observed under ethane-hydroxy diphosphomate (EHDP) administration, today amino-hydroxy-propylidine diphosphonate (APD) and dichloromethylene diphosphonate (clodronate) are preferred in the treatment of Paget's disease. Diphosphonates inhibit both osteoblasts and osteoclasts, thus being also used in the treatment of primary osteoporosis. Their efficacy in high-turnover osteoporosis in the form of monotherapy or within the framework of cyclical therapy schemes has been demonstrated by an increase in bone mass. Diphosphonates have played an important role in the therapy of steroid-induced osteoporosis. Prevention of osteopenic changes is of utmost significance: a prophylactic effect was demonstrated in immobilization osteoporosis. In prophylaxis, diphosphonates might also be applied in women after ovariectomy who had to undergo surgery before the menopause due to oncologic indications and in whom the administration of estrogens to prevent expected osteoporosis is contra-indicated. The favorable effect of diphosphonates on bone changes in Gaucher's disease implies an inhibition of macrophage-mediated bone resorption. The importance of this substance in orthopedics will further contribute to prevent ectopic ossification in hip endoprosthetics.