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Arthritis und Rheuma 2017; 37(06): 395-400
DOI: 10.1055/s-0038-1624236
Osteologie aktuell
Schattauer GmbH

Osteoporose bei Typ-1-und Typ-2-Diabetes mellitus

Osteoporosis associated with type 1 and type 2 diabetes mellitus
S. Scharla
1   Internist und Endokrinologe/Diabetologe, Osteologe DVO, Bad Reichenhall
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Publication History

Publication Date:
10 January 2018 (online)

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Zusammenfassung

Diabetes mellitus und Osteoporose sind häufige Erkrankungen. Deshalb gibt es viele Patienten, die an beiden Krankheiten gleichzeitg leiden. Darüber hinaus stellt jedoch sowohl der Typ-1-als auch der Typ-2-Diabetes mellitus jeweils eine prädisponierende Erkrankung dar, die das Risiko für Osteoporose und Frakturen erhöht. Dabei ist das Risiko bei Typ-1-Diabetes mellitus stärker ausgeprägt, während bei Diabetes mellitus Typ 2 vor allem Patienten mit längerer Krankheitsdauer, schlechter Stoffwechsellage, Insulinpflichtigkeit und vaskulären Folgeschäden frakturgefährdet sind. Die Knochendichte ist bei Typ-1-Diabetes mellitus erniedrigt, während insbesondere adipöse Typ-2-Diabetes-Patienten auch höhere Knochendichtewerte aufweisen können. Das Fraktur-risiko wird nicht nur durch Veränderungen der Knochendichte und der Knochenarchitektur erhöht, sondern auch durch veränderte Knochenmaterialeigenschaften (veränderte Kollagen-Quervernetzung). Pathogenetische Faktoren sind Hyperglykämie, hormonelle Veränderungen, und der Einfluss von oralen Antidiabetika. Während Inkretine und DPP-4-Hemmer das Frakturrisiko zu senken scheinen, sind Glitazone mit höherem Risiko assoziiert. Auch SGLT-2-Hemmer könnten bei eingeschränkter Nierenfunktion mit einem höheren Frakturrisiko behaftet sein. Die Therapie der Osteoporose bei Diabetes mellitus unterscheidet sich nicht vom Vorgehen bei primärer Osteoporose. Die Effizienz von antiresorptiven Medikamenten wird nicht durch Diabetes mellitus beeinflusst.

Summary

Diabetes mellitus and osteoporosis occur with high prevalence. Therefore, there are many patients suffering from both diseases. However, both diabetes mellitus type 1 and type 2 are predisposing risk factors leading to a disease-associated increase in osteo porosis and fractures. Diabetes mellitus type 1 causes a marked increase in fracture risk, whereas in Diabetes mellitus type 2 fracture risk is dependent on disease duration, bad metabolic state, insulin therapy and vascular complications. Bone mineral density is decreased in diabetes mellitus type 1, whereas an increased mineral density may be found in type 2, especially when obesity is present. Fracture risk is related to bone mineral density and bone architecture, but also influenced by bone material quality like altered collagen crosslinking. Pathogenic factors are hyperglycaemia, hormonal changes, and the influence of oral antidiabetic drugs. Incretins (glucagon-like-peptides) and DPP-4-inhibitors seem to decrease the fracture risk, whereas glitazones increase the fracture risk. SGLT-2-inhibitors could be associated with an increased fracture risk in patients with impaired renal function. The treatment of osteoporosis in patients with diabetes mellitus is not different from the management of idiopathic osteoporosis. The efficacy of anti-resorptive treatment is not diminished by diabetes mellitus.

Schlüsselwörter

Diabetes mellitus - sekundäre Osteoporose - Frakturrisiko

Keywords

Diabetes mellitus - secondary osteoporosis - fracture risk
 

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