Effekte der Glukokortikoide auf den Knochen

Zusammenfassung

Glukokortikoide sind potente Modulatoren des Immunsystems mit antientzündlicher und immunsuppressiver Wirkung. Seit ihrer Einführung in die klinische Medizin werden Glukokortikoide sehr breit angewandt und kommen sowohl in sehr niedrigen bis sehr hohen Dosierungen zum Einsatz. Trotz der vielen positiven Eigenschaften der Glukokortikoide ist ihre Anwendung vor allem in höheren Dosierungen oft durch zahlreiche Nebenwirkungen gekennzeichnet. Eine typische unerwünschte Wirkung einer solchen Therapie ist die glukokortikoidinduzierte Osteoporose, die die häufigste sekundäre Osteoporoseform darstellt. In den vergangenen Jahren konnte das Wissen über die Glukokortikoidwirkungen auf den Knochen deutlich erweitert werden. Es wurde klar, dass Glukokortikoide dosis- und zeitabhängig sehr verschiedene Wirkungen auf dieses System haben. Während Glukokortikoide in physiologischer Konzentration eine regulatorische Wirkung auf die Osteoblastogenese haben und so die Knochenbildung begünstigen, sind ihre Auswirkungen in pharmakologischer Dosierung nahezu konträr. In diesem Beitrag geben wir einen Überblick über physiologische und pathophysiologische Glukokortikoideffekte auf den Knochen und beleuchten aktuelle Therapieempfehlungen bezüglich der glukokortikoidinduzierten Osteoporose.

Summary

Glucocorticoids represent highly effective modulators of the immune system with antiinflammatory and immunosuppressive characteristics. Since their introduction into clinical medicine, glucocorticoids have been widely used in the treatment of several different diseases. Their application ranges from very low to very high doses. In spite of their many positive features, numerous adverse effects often limit the therapeutic use of glucocorticoids especially if they are given at larger dosages for a longer time. One typical adverse effect is the occurrence of glucocorticoid-induced osteoporosis, which represents the most common form of secondary osteoporosis. During the last years our knowledge about mechanisms of glucocorticoid-induced bone changes has increased considerably. It became obvious that glucocorticoids have both time and dose-dependent effects on bone. Also, they have regulatory functions on osteoblastogenesis and facilitate bone development at physiological concentrations, whereas their effects at pharmacological concentrations are almost contrary. In this article, we provide an overview on physiological and pathophysiological actions of glucocorticoids on bone and highlight current therapeutic strategies for glucocorticoidinduced osteoporosis.

Schlüsselwörter

Glukokortikoide - Knochen - Osteoporose

Keywords

Glucocorticoids - bone - osteoporosis

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