Diagnostik und Therapie der Osteoporose bei Diabetes mellitus

L. C. Hofbauer; F. Jakob

doi:10.1055/s-0037-1620042

Osteologie, Table of Contents

Osteologie 2014; 23(02): 100-106
DOI: 10.1055/s-0037-1620042

Osteoporose und Diabetes mellitus

Schattauer GmbH

Diagnostik und Therapie der Osteoporose bei Diabetes mellitus

Diagnosis und therapy of osteoporosis in patients with diabetes mellitus

L. C. Hofbauer

¹Bereich Endokrinologie/Diabetes/Knochenerkrankungen (LCH), Medizinische Klinik III, Universitätsklinikum Dresden, Dresden

,

F. Jakob

²Orthopädisches Zentrum für Muskuloskelettale Forschung, Experimentelle und Klinische Osteologie (FJ), Universität Würzburg, Würzburg

› Author Affiliations

Abstract

Zusammenfassung

Ein Diabetes mellitus beeinträchtigt das Skelettsystem und ist ein starker Risikofaktor für die Entwicklung einer Osteoporose mit Fragilitätsfrakturen. Die zugrundeliegenden Mechanismen für die erhöhte Fragilität des Knochens sind unzureichend bekannt, umfassen jedoch direkte und indirekte Effekte einer chronischen Hyperglykämie auf den Knochenstoffwechsel. Beim Typ-1-Diabetes mellitus (T1DM) ist das Skelett deutlich stärker betroffen als beim Typ-2-Diabetes mellitus (T2DM), insbesondere durch diabetische Komplikationen. Die Knochendichte kann bei Patienten mit T2DM sogar erhöht sein, schützt aber offenbar aufgrund einer eingeschränkten Qualität weniger gut gegen Frakturen. Orale Antidiabetika vom Typ der Glitazone fördern den Knochenverlust und sollten daher bei Osteoporose vermieden werden. Ein körperlich aktiver und gesunder Lebensstil, eine konsequente Prävention und Therapie diabetischer Komplikationen sind zusammen mit einer Basistherapie bestehend aus Kalzium und Vitamin D die Säulen der Behandlung der Osteoporose bei T1DM und T2DM. Die Messung der Knochendichte und die Bestimmung anderer Risikofaktoren dienen der Festlegung einer risikoadaptierten spezifischen Therapie. Auch wenn sie nicht spezifisch bei Diabetikern untersucht wurden, scheinen sämtliche etablierte Osteo porosetherapien bei Patienten mit Diabetes mellitus wirksam zu sein.

Summary

The diagnosis of diabetes mellitus impairs the skeleton and represents a risk factor for osteoporotic fractures. The underlying mechanisms are not fully understood, but may include direct and indirect effects of chronic hyperglycemia on the skeleton. In general, bone metabolism is more severely affected in type 1 diabetes mellitus (T1DM) as compared to type 2 diabetes mellitus (T2DM), especially in the presence of diabetic complications. Bone mass may even be high or normal in patients with T2DM, but this does not confer protection against fractures as a result of reduced bone quality. Glitazones used as oral antidiabetic drugs promote bone loss and should not be used in patients with osteoporosis. A physically active lifestyle with healthy nutrition, including adequate uptake of calcium and vitamin D, along with comprehensive prevention of diabetic complications, represent basic therapeutic measures. Identification of risk factors, assessment of bone mineral density, and laboratory tests help to develop an individualized specific treatment plan. In patients with diabetes mellitus, all established osteoporosis drugs seem to be effective.

Schlüsselwörter

Diabetes mellitus - Osteoporose - Fragilitätsfrakturen

Keywords

Diabetes mellitus - osteoporosis - osteoporotic fracture

Full Text

References

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