Manejo farmacológico de la pérdida ósea en pacientes con espondilodiscitis. Revisión sistemática
Resumen
Introducción: El defecto óseo lítico es una consecuencia devastadora y muy frecuente del paciente con espondilodiscitis, y es responsable del colapso y la inestabilidad. En la actualidad, no existe una pauta para el manejo farmacológico. Objetivo: Revisar la evidencia científica publicada sobre el tratamiento farmacológico de la pérdida ósea secundaria a espondilodiscitis. Materiales y Métodos: Se realizó una búsqueda sistemática en bases de datos de referencia médica para hallar estudios sobre el uso de teriparatida, romosozumab o denosumab en pacientes con defecto lítico asociado a espondilodiscitis piógena, tuberculosis vertebral. Resultados: En dos artículos, se comunicó la mejoría de la densidad mineral y la formación osteoblástica con el uso de teriparatida en pacientes con defecto óseo u osteoporosis asociada a infección vertebral; las reacciones adversas fueron escasas, no hubo interacción con los antibióticos, y uno de ellos cuando se complementó con romosozumab. Un tercer artículo informó mejoría en los osteoblastos infectados. Asimismo, los bifosfonatos y el denosumab provocaron malos resultados y empeoraron la infección. Conclusiones: El uso de fármacos anabólicos, como teriparatida y romosozumab, promete ser una excelente opción para el tratamiento de la pérdida ósea y la osteoporosis severa en casos de infección vertebral, con escasas reacciones adversas. Se requieren estudios clínicos para verificarlo.Descargas
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