Diabetes mellitus und Osteoporose

N. Ewald

doi:10.1055/s-0037-1618148

Arthritis und Rheuma, Table of Contents

Arthritis und Rheuma 2012; 32(06): 367-374
DOI: 10.1055/s-0037-1618148

Sekundäre Formen der Osteoporose

Schattauer GmbH

Diabetes mellitus und Osteoporose

Diabetes mellitus and osteoporisis

N. Ewald

¹Medizinische Klinik und Poliklinik III, Universitätsklinikum Gießen und Marburg, Standort Gießen

› Author Affiliations

Abstract

Zusammenfassung

Zahlreiche Studien belegen eine Assoziation der beiden großen Volkskrankheiten Diabetes mellitus und Osteoporose. Während bei Patienten mit Typ-1-Diabetes meist eine verminderte Knochendichte nachweisbar ist, weisen Typ-2-Diabetiker oft eine normale oder erhöhte Knochendichte auf. Bei beiden Formen des Diabetes mellitus scheint die Knochenbrüchigkeit der jeweils vorhandenen Knochenmasse jedoch erhöht. Eine gesteigerte Frakturgefährdung sowohl für Typ 1 als auch Typ 2 ist in Metaanalysen gut dokumentiert. Normale bis erhöhte Knochendichtewerte bei Typ-2-Diabetikern verzerren jedoch das Frakturrisikoprofil bei alleiniger Betrachtung der DXA-Messung, so dass ein vermehrtes Bewusstsein für Frakturen als Manifestation einer gestörten Knochenqualität notwendig ist. Verantwortliche Faktoren für das erhöhte Frakturrisiko können u. a. das Fehlen osteoanaboler Effekte durch Mangel an Insulin und anderer osteoanaboler Substanzen (z. B. IGF-1, Amylin, etc.) sein, eine vermehrte Bildung von Advanced Glycation End Products (AGE) sowie mikrovaskuläre und neuro pathische Komplikationen. Das Frakturrisiko insbesondere älterer Diabetiker ist zudem durch die erhöhte Sturzneigung bei Vorliegen diabetischer Sekundärkomplikationen gesteigert.

Summary

Numerous studies show an association between diabetes mellitus and osteoporosis. While low bone mineral density (BMD) is consistently observed in type 1 diabetes, patients with type 2 diabetes often show normal or increased BMD. Yet, both type 1 and type 2 diabetes are associated with a higher risk of fractures. Normal or increased BMD in type 2 diabetes may by misleading when judging the risk of fracture merely by DXA-scan. Increased awareness of altered bone quality as an underlying cause of fractures is necessary. Lack of insulin and other osteoanabolic factors (e. g. IGF-1, amylin), increased concentrations of AGE as well as microangiopathy and neuropathy may contribute to the increased fracture risk. In older patients with diabetes mellitus, the elevated fracture risk is additionally attributable to the higher risk of falling especially when secondary diabetic complications are present.

Schlüsselwörter

Diabetes mellitus - Osteoporose - Frakturen

Keywords

Diabetes mellitus - osteoporosis - fractures

Full Text

References

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